The Assembly met at 13:30 with the Llywydd (Elin Jones) in the Chair.

I call the National Assembly to order.

1. Statement by the Llywydd: Appointment of the New Chief Executive and Clerk of the Assembly

As you all know, the Chief Executive and Clerk of the Assembly, Claire Clancy, has decided to retire following almost a decade in the role. The clerk is the most senior Commission employee and our principal accounting officer. It’s the responsibility of the Assembly Commission to make the appointment to this post and, over the last few months, we have conducted a rigorous, competitive recruitment process to find a replacement for Claire. We were looking for an exceptional individual and we attracted a strong field of candidates. I’m delighted to announce the appointment of Manon Antoniazzi as our next chief executive and clerk. Manon has had an impressive career and brings a wealth of experience at a time when we face many new challenges and opportunities. Manon is currently director of culture, sport and tourism for the Welsh Government, having been chief executive of Visit Wales. Earlier in her career, she had roles at the BBC and S4C, as well as with the Prince of Wales. The Commissioners are in no doubt that Manon will approach the role with great skill and enthusiasm, and a passionate commitment to the success of the Assembly. The performance of the Assembly Commission has a direct impact on the success and reputation of the Assembly. We rely heavily on the chief executive to provide innovative, effective leadership, and to deliver exceptional standards of service. Thanks to Claire and our hugely committed, talented staff, the Commission is a highly regarded organisation, much admired by parliaments elsewhere. Claire will be with us until Easter, when Manon will take up the reins to lead the organisation through the next exciting and challenging phase of our development at the heart of democracy for Wales. Thank you.

2. 1. Questions to the Cabinet Secretary for Economy and Infrastructure

[R] signifies the Member has declared an interest. [W] signifies that the question was tabled in Welsh.

And, so, we move on to the first item on our agenda this afternoon, namely questions to the Cabinet Secretary for Economy and Infrastructure, and I call on the first question—Janet Finch-Saunders.

<p>A North Wales Tidal Lagoon</p>

Janet Finch-Saunders AC: 1. Will the Cabinet Secretary make a statement on the potential economic benefits of a north Wales tidal lagoon? OAQ(5)0114(EI)

Ken Skates AC: Yes. A north Wales tidal lagoon has the potential to create considerable jobs in north Wales. And we have consistently stated our commitment, in principle, to supporting the development of a sustainable tidal lagoon industry right across Wales.

Janet Finch-Saunders AC: Thank you, Cabinet Secretary, and I’m sure you would agree with me in welcoming the Hendry review, and the positive support therein for tidal lagoon developments across Wales. For us in north Wales, such a project would provide essential flood protection, deliver significant employment and economic inward investment opportunity, and contribute towards helping Wales to become a world leader in renewable energy. A number of stakeholders have already pledged their support, and I’m glad that you pledge your support in principle. The Welsh Conservatives group pledge their support for tidal lagoon technology in Wales. But will you also back that up, please, with some commitment towards any funding that is needed to make that project a reality?

Ken Skates AC: Well, we are fully committed to this project, and I’ll be meeting with Charles Hendry later this afternoon to talk about the pathfinder project in particular, which would lead eventually to the creation of a tidal lagoon in north Wales. It’s a project that could potentially create 27,000 jobs for the north Wales economy. It would also, as the Member highlighted, contribute to the defence of coastal communities, and this is something that is very much of great concern to the Welsh Government, and it’s something that I’ve spoken with the Cabinet Secretary for environment and natural resources about very recently. So, we are very enthusiastic about this project. We are supportive and, of course, we’ll work right across Government, including with the regional skills partnerships, to ensure that the skills are there to deliver the project in a timely fashion, were it to go ahead.

Jeremy Miles AC: Tidal lagoons are one manifestation of Wales’s blue economy, which, as well as energy, also encompasses fishing and aquaculture, and tourism and leisure. Wales has a strong advantage in this area against other countries that don’t have the same coast and high tidal reach. What priority will the Cabinet Secretary give to Wales’s blue economy in the new economic strategy, and what steps can he take to ensure that firms, large and small, are able to take advantage of this opportunity?

Ken Skates AC: I’d like to thank Jeremy Miles for his question, and also thank him for a very insightful piece on his website, concerning the blue economy. I think it’s very timely that we’re talking about this particular subject, as we start planning for 2018, which has been designated the Year of the Sea. And, for the purpose of growing visitor numbers, of course, the blue economy will be increasingly important.In terms of existing opportunities, we are committed to taking advantage of every major blue economy infrastructure project across Wales, including the Swansea bay tidal lagoon pathfinder project, subject, of course, to the necessary consents being in place. I am determined to make sure that coastal communities take advantage not only of initiatives such as the Year of the Sea, but also of major infrastructure projects, and that the supply chain around Wales, and particularly in coastal communities, is able to exploit those major opportunities for economic growth.

Llyr Gruffydd AC: It was good to hear Charles Hendry briefing Members of the Assembly at lunchtime, and one of the points that he made, of course, is that it is his recommendation that there should be a delay after the development of the first project in order to learn lessons from it. One understands why that would be beneficial, but there is recognition in that regard that that may create problems for the new supply chains that we intend to develop around the Swansea project. Whilst he is calling on the UK Government to demonstrate a long-term plan in terms of major projects, he’s also suggesting that we need to look at a series of smaller projects in order to maintain the supply chain in the interim, until we reach the point where we can be confident in moving forward with a number of larger projects. Can I ask what work the Welsh Government is undertaking to identify the potential for a series of smaller projects along the Welsh coastline in order to ensure that that supply chain does have the medium-term resilience and sustainability to survive the long term?

Ken Skates AC: This is a really important point the Member raises, and I’ve talked in the past about the need to have a constant pipeline of major infrastructure investments, but one that also mixes in smaller investments that can maintain people and employment whilst waiting or transitioning from one major project to the other. And for that reason, we’re working with local government, with skills providers, and with businesses, to ensure that we’re able to identify a time frame for major projects to take place in, but also one that ensures that, between the major projects, we’re able to identify opportunities for companies to grow and to prosper from smaller scale projects. One of the key issues that I’ll be raising this afternoon with Charles Hendry, and it’s something that the Member has already touched on, is how long the pathfinder programme is envisaged to last for, because this will have, as the Member rightly says, knock-on effects not just on the Swansea bay project, but also on tidal lagoon projects right across Wales.

<p>Business Growth</p>

Angela Burns AC: 2. Will the Cabinet Secretary outline what discussions he has had with the Cabinet Secretary for Finance and Local Government in relation to the growth of business in Wales? OAQ(5)0111(EI)

Ken Skates AC: I meet regularly with the Cabinet Secretary for Finance and Local Government, and the wider Cabinet, to discuss a range of economy and infrastructure issues within my portfolio, including, of course, business growth.

Angela Burns AC: Thank you for that, because, as you will recognise, developing and growing a business in today’s climate is harder than ever and there are a number of issues that business owners cite as barriers to growth for their businesses—lack of structured borrowing and capital from the banking sector is one. However, many talk about the barriers from local authorities and other public sector organisations, ranging from Natural Resources Wales to transport infrastructure. Planning is key, and I recognise that both you and the Cabinet Secretary for finance don’t have responsibility for that. But what I’m really trying to elucidate is a sense that there is a coherent strategy around the Cabinet table that encourages and empowers businesses to thrive. The economy is our lifeblood. What else do you think, Cabinet Secretary, could be done to ensure that untimely delays, a lack of vision and disjointed thinking in public services doesn’t impede the growth of our economic health?

Ken Skates AC: I’d like to thank Angela Burns for her question. Since I was appointed to this post, I’ve embarked on numerous engagement opportunities with the business community, and the points that the Member raises today have been relayed to me on numerous occasions. For that reason, I engaged directly and constructively with the Cabinet Secretary for Finance and Local Government in the drafting of the White Paper, which will be presented shortly, on local government. And I think it’s absolutely essential that we recognise that there are barriers that still exist that inhibit economic growth. For that reason, I’ve asked every department in Government to draft formally a competitiveness plan that can fuel economic growth within the private sector.

David Rees AC: Cabinet Secretary, your predecessor introduced enterprise zones as a means of actually growing the economy in particular areas across Wales and, last year, she introduced an enterprise zone in Port Talbot. What are you doing with your colleagues to ensure that the enhanced capital allowances can be extended beyond the time we’ve already been given, so that the enterprise zone, which we all know does not take one year but several years to establish itself, can get established? What he also told me in discussions with him was that capital allowances were needed to build the sites and grow spaces, which is square footage that we haven’t got elsewhere in Wales, to allow businesses to come in and use them, enabling them to grow.

Ken Skates AC: This is one of the points that has been raised by Chris Sutton on numerous occasions with me during, again, the engagement programme that I’ve had with businesses. It’s absolutely central that we recognise that many of the premises that were built to attract investors are now reaching a point where they require either major investment or replacement. So, it’s going to become an increasingly important aspect of the prosperous and secure strategy, as we move forward to a post-Brexit existence.I think also in terms of enterprise zones and the support that we’ve been able to provide through business rates, we’ve been able to already support 200 businesses with approximately £9 million of funding through the scheme. But there are other ways in which Welsh Government can act as an enabler of economic growth and business growth, and, of course, the provision of modern fit-for-purpose premises is one of those means by which we can encourage economic growth and prosperity.

Vikki Howells AC: Minister, as you will be aware, proposals to develop a circuit of Wales have been circulating for some time. Up to now, the project team have been unable to raise the necessary finance for the project. Would you be able to outline what recent developments there have been?

Ken Skates AC: Like the Member, I’m concerned that the circuit of Wales project has been publicly debated for many years without the team yet being able to raise the necessary private finance to bring the project to fruition. The proposals have changed, of course, over the years, since 2011. Last July, I made it clear what our position as a Welsh Government is. I stated clearly in this Chamber that we require a minimum of 50 per cent of the capital and 50 per cent of the risk of the project to be taken by the private sector. Should that happen, we will consider any new proposal against the appropriate value-for-money and due diligence tests. The people of Ebbw Vale, as the Member has already identified, deserve to know if this project is going ahead and, crucially, if so, when. I’m keen to avoid the opportunity costs associated with a project that does not have a final end date. So, I have therefore written to the Heads of the Valleys development corporation today, asking them to make faster progress on this project and asking for evidence to be provided to me of named investor term sheets within the next two weeks.

<p>Questions Without Notice from Party Spokespeople</p>

Questions now from the party spokespeople. First, the Plaid Cymru spokesperson, Adam Price.

Adam Price AC: Diolch, Lywydd. As the Cabinet Secretary will be aware, I and my party colleagues were roundly condemned for expressing our sincere belief, echoed by many steelworkers, that the current package of proposals on offer from Tata needed to be radically improved to make it fair and acceptable for workers. It was therefore gratifying to see as a headline in the ‘Llanelli Star’ earlier this week this picture of the AM for Llanelli and the MP for Llanelli, under the headline, ‘Leading Llanelli politicians tell Tata Steel: ‘"Re-think pension deal"‘. Now, the Labour MP for Llanelli said of Tata’s proposals that steelworkers have every right to be angry and expressed her hope that even now, just days before the vote, it is not too late for Tata to look again and offer a better deal, even though we’ve heard, of course, from some of the Labour benches the argument that there’s no alternative. Does the Cabinet Secretary agree with the Shadow Secretary of State for Defence that workers are right to be angry and that Tata urgently needs to rethink its proposals?

Ken Skates AC: I think the Member is right to say that workers should be concerned about the future of the steel industry, but it does nobody any favours to politicise what is an incredibly sensitive matter. It’s not often that I would agree with the leader of the opposition, but I do think that he was right to tweet that there was no place for political posturing in what is an incredibly important debate about pensions, which could then determine the long-term sustainability of the steel industry. I think what the Member for Llanelli has said reflects the concern not just within this Chamber, but in the wider communities where steel is so important, that there should be the best possible deal for steelworkers on the table for their pensions, but this is the only deal that’s there at the moment, and the First Minister and I have been very clear in our views that the debate should be conducted without any political interference whatsoever.

Adam Price AC: I gave the Cabinet Secretary the opportunity there to support his own members—members of his own party—who are simply doing their job, actually, and I actually support them in what they’ve said. We’ve said the same—this deal is not good enough, and, really, he should be using his position and that of the Welsh Government to actually get a revised proposal. Now, earlier this week, the UK Government published its own industrial strategy, the Green Paper. Was he as surprised as me to see that steel only had a single passing reference in a 132-page document?To be fair, there were some areas that present opportunities for Wales, so will he be proposing steel as one of the areas for a sector deal? Will the Welsh Government take up the offer of a joint ministerial forum on industrial strategy? Does he welcome the commitment to move cultural institutions and Government bodies, including research bodies, outside of London to support economic development? Does he welcome the long-overdue commitment by the UK Government to take into account the current regional imbalance in investment in infrastructure in making future investment decisions?

Ken Skates AC: I was pleased to be able to speak with Greg Clark at length on Monday ahead of the publication of the strategy. I agreed with the Secretary of State that joint chairmanship of the forum would be something that I would desire. I also spoke with him about a specific steel sector deal—this is something that we’re going to be discussing in the coming weeks.I was surprised how little reference there was to steel within the strategy. However, I have made it clear that I wish to see steel become a major component of the industrial strategy’s work moving forward. I’m also keen—the Member is aware that I am keen—to decentralise wherever possible. So, whether it concerns investment or innovation, I would like to see more opportunities given to companies outside the intensely urbanised areas where, traditionally, financial institutions and innovation bodies are based.

Adam Price AC: Of course, it’s often all too easy to attack the UK Government, and sometimes they make it too easy for us, but there are some things we can learn here, surely. At least they’ve got a strategy. It’s taken the new administration just six months to produce an industrial strategy. Where is our Welsh Government economic strategy that we were promised in June? Has research been commissioned? When can we see a draft? Will the Welsh Government commit to equalising infrastructure investment between the regions? There’s a 5:1 gap between the south-east of England and Wales; there’s a 3:1 gap between the south-east of Wales and my own region. Will it commit to locating the Welsh Revenue Authority outside the south-east? It’s good to see the decision imminent on the Circuit of Wales, but will other investment projects outside the south-east that have been languishing in his ministerial in-tray, like the Egin in west Wales, finally see a decision so that we can get on and create investment and jobs outside of one corner of Wales?

Ken Skates AC: I think the Member should reflect on what his colleague said yesterday about ensuring that due diligence is followed and thoroughly pursued—it’s absolutely essential. So, whether it’s Yr Egin or any other project, we do pursue due diligence rather than rush hastily into an investment that may not offer best value for money for the taxpayer.In terms of the UK Government’s strategy, although the Member may wish to ignore the fact that a UK Government exists, we will not ignore that fact. One of the messages that came across clearly from businesses the length and breadth of Wales whilst I was consulting with them over the contents and the vision within our strategy is that we need to take account of what the UK industrial strategy presents for Wales. We could not have produced a strategy that did not take account of the key elements of the vision of the UK Government, whether we like that or not.

The Welsh Conservatives’ spokesperson, Russell George.

Russell George AC: Diolch, Presiding Officer. I do have no doubt that the Cabinet Secretary will agree with me that small businesses are vitally important, of course, to the Welsh economy. But I have to say that small businesses haven’t been afforded the stability I think they need from past and this Welsh Governments. Business rates have been devolved for some time, and businesses are still at a significant disadvantage to their counterparts in England—indeed, they’re crying out for support. Given that there has been a 26 per cent drop in new business start-ups since 2011, do you think that the Welsh Government should give potential entrepreneurs and businesses the security that they need by raising the rateable value for small business rate relief from 1 April this year?

Ken Skates AC: Well, in terms of business rate relief, this is obviously something that’s in the hands of my colleague, the Cabinet Secretary for Finance and Local Government, but what I am pleased with is that the scheme is to be extended for 2017-18, and that a new permanent scheme will exist from 2018 onwards. We’re already providing something in the region of £98 million in rate relief to businesses in 2016-17. I think it’s worth noting, because you made the direct comparison with England, that around 70 per cent of businesses qualify for relief, and around half of all eligible businesses pay no rates whatsoever.

Russell George AC: Well, Welsh businesses are already losing out to their competitors in England and Scotland. England and Scotland have already raised the levels of small business rate relief there. Furthermore, the development bank you are proposing is a hybrid model of Finance Wales—indeed, it provided the business case. Now, I had an example last week where I went to visit a business. Their rateable value had gone up. They would have received rate relief if they were in England—they don’t because they’re in Wales. Furthermore, they applied to Finance Wales for funding—indeed, Finance Wales sat around the table and helped them complete the application form—yet it was rejected. So, what I’ll say is: how is your Government going to provide the certainty and security to those businesses? Your White Paper, while concerned about the potential of the UK departing from the single market, offered no suitable plan for small businesses in particular during negotiations to leave the EU. Now, you’ve been asked this once today, but I will ask it again: where is your industrial strategy in this regard?

Ken Skates AC: The prosperous and secure strategy, which forms part of four cross-cutting strategies for Welsh Government, will be presented to the First Minister, along with the other three strategies, this spring. They will be published together, and through all four I think Members will be able to see that themes and interventions can be woven right across not just the economy, but the public sector, through education and through health. We live in a society, and we live in an environment, where economic priorities often align perfectly with the priorities of other areas of Government, and it’s therefore essential that we don’t just devise a strategy for the economy that’s in isolation from other strategies, but that we do it together. And that is something that I am keen to pursue. So, by spring, we will have presented to the First Minister our respective strategies—we are already meeting as Cabinet colleagues to agree the contents. I can’t possibly comment on the individual matter the Member raised on Finance Wales. I would however say that I’d be glad to take this up on behalf of him if he writes to me. I’ll take it up directly with Finance Wales as well.

Russell George AC: Thank you, Cabinet Secretary, I’ll do that and I’m grateful for that. The Prime Minister’s industrial strategy has indicated that significant investment will be made towards research and development, and to training, so that our workforce is ready to deal with the challenges innovation will bring. Indeed, it states that we should be ‘creating the right conditions for new and growing enterprise to thrive, not protecting the position of incumbents.’Now, in Wales, we have to consider also the implications of the Northern Powerhouse, which has been given an additional £4.7 billion by 2020-21 in R&D funding through its investment fund. And I would say, Cabinet Secretary, to my last question you did answer regarding having a joined-up strategy, and I agree with that position. But I would ask: would it not have been better to have a strategy to accompany the White Paper that you delivered this week?

Ken Skates AC: I think it’s absolutely essential, with regard to the Northern Powerhouse, that the growth deal in north Wales dovetails perfectly with the aspirations and the vision that local authorities and the local enterprise partnerships have across the border. For that reason, I’ve been quite clear in saying that, ultimately, I would envisage a joint committee structure that perhaps crosses the border. That would be the ultimate objective of what is, essentially, an east-west economy in the north. I think it’s absolutely essential that local authorities as they move from the North Wales Economic Ambition Board to a joint committee structure, recognise that doing business with partners across the board, not just in terms of growing the economy, but also in terms of delivering better public services and improving public transport, is absolutely essential.

UKIP spokesperson, David Rowlands.

David J Rowlands AC: Diolch, Lywydd. As the Cabinet Secretary knows, I’m very enthusiastic about the metro plans and look forward to its implementation. However, can he outline exactly what specific structural improvements the metro will make to one of my constituencies, namely Torfaen?

Ken Skates AC: Well, we’ll be investing more than £700 million in the metro, and this will see vast improvements to infrastructure and to the travelling experience of many, many commuters across south-east Wales. I was very grateful that the Member was able to attend last week’s briefing session on the next rail franchise, which, of course, included a briefing on the metro as it’s going to be rolled out and, with new services commencing in 2023, I think it’s absolutely essential that all parts of south-east Wales that have felt cut off, isolated and marginalised within the context of economic growth in recent years feel empowered through new stations and infrastructure, and that includes in Torfaen, where I am looking very carefully at what infrastructure improvements, both to existing infrastructure and to new infrastructure, can be delivered as part of the metro vision.

David J Rowlands AC: I thank the Cabinet Secretary for his answer, but I understand that Torfaen County Borough Council has pledged some £11 million to the project. Does he honestly feel this level of investment gives good value for money, given what he’s just outlined?

Ken Skates AC: Well, Torfaen is a small local authority; I think we need to recognise that. And therefore £11 million, whilst, in the greater scheme of things, when we talk about more than £700 million, might appear a small sum, actually, to a small local authority, to a relatively small council, £11 million is a significant investment and demonstrates, I feel, a commitment to a vision that I think, right across the Chamber, we all buy into.

David J Rowlands AC: Again, I thank the Cabinet Secretary for his answer, but can I urge him, perhaps, to make some improvements to the infrastructure in Torfaen? For instance, the Pontypool Road railway station is particularly uninviting: it’s cold, it’s dark and, actually, it’s well outside the town. So, would he consider at least upgrading the facilities on Pontypool Road or, indeed, consider moving it closer to the conurbation of Pontypool?

Ken Skates AC: I’ll consider any project as part of a wider investment by Network Rail that delivers better value for money and a better experience for passengers. I think the Member may be aware of this statistic—it’s quite startling—that Welsh Government have invested more in the current control period in rail infrastructure than those who are actually responsible for rail infrastructure, and I think that speaks volumes about the commitment of this Government to improving the rail network and to ensuring that Wales becomes a more united and connected country.

<p>The Role of Faith Tourism</p>

Suzy Davies AC: 3. Will the Cabinet Secretary make a statement on the role of faith tourism? OAQ(5)0107(EI)

Ken Skates AC: Yes. Visit Wales continues to promote faith and religious heritage sites as part of the overall heritage offer. Our Year of Legends will focus very much on all aspects of Wales’s heritage.

Suzy Davies AC: That’s encouraging to hear. Faith tourism sites, such as Neath Abbey, and other Cistercian Way heritage, should be a huge draw for visitors, both domestic and from abroad, and particularly from the USA. Last year, you launched the faith tourism action plan to develop faith tourism as part of that wider visitor offer. How are you measuring its success, and can you say yet that it is persuading visitors to stay longer and spend more, both on and off-site?

Ken Skates AC: We can if we look specifically at those sites that we measure visitor numbers for. So, for example, with the Cadw sites that are related to the question the Member asks, we’ve seen a considerable increase in visitor numbers. And, in terms of the associated spend, we’ve seen again an increase. We’ve seen, for example, with Cadw properties at Tintern and Valle Crucis and Strata Florida, between them, they’ve attracted more than 84,000 visitors. Now, in terms of the faith tourism action plan, of course, it’s very early days in the actual delivery of that action plan, but Visit Wales—and I think it’s a very important point that Visit Wales sits on the newly established forum that stemmed from the faith tourism action plan task and finish group, because it’s essential, in terms of protecting the future heritage of faith structures, that we have the key promotional vehicle there, offering advice and also offering a willingness to promote right around the globe some of the key features of what Wales can offer.

Mike Hedges AC: Last week, I was visited by a constituent interested in promoting faith tourism who was actually creating a website to do that for the south Wales area. Ireland had a signature project on St Patrick and the Christian heritage. Have the Welsh Government considered a similar project on St David and will the Government also consider a policy to protect key sites and market these sites around the world?

Ken Skates AC: Yes, we already do that with the faith tourism section of the Visit Wales website. I think it’s important that we don’t see an overabundance of websites and web pages dedicated to what essentially are the same subjects, and that instead we are able to direct visitors who are looking to learn more about faith tourism to key portals. For that purpose, I am going to encourage the Member to, in turn, encourage his constituents to make sure that anybody who creates a website dedicated to a single or multiple heritage centre or a heritage visitor attraction directs people to the Visit Wales website, where they can learn more not just about what is in that very localised area, but right across Wales. We’ve been able to develop, through Cadw, a pan-Wales heritage interpretation plan—the first of its type in Europe—and that demonstrates how we are committed to capturing the essence of a Wales-wide cultural offer and promoting it across the globe. In terms of the outcomes—and the Member mentions the need to promote our sites better right across the globe—in terms of international visitors, it was a record year last year and one of the key factors that has attracted visitors to Wales is faith tourism sites. I’m convinced that, during the Year of Legends, that will remain so.

<p>Reducing Congestion in Town Centres</p>

Julie Morgan AC: 4. What plans does the Cabinet Secretary have to reduce congestion in town centres? OAQ(5)0115(EI)

Ken Skates AC: Our national transport finance plan sets out the interventions we are taking to tackle congestion and provide sustainable alternatives to car use.

Julie Morgan AC: I thank the Cabinet Secretary for the response. Does the Cabinet Secretary agree that it’s very good news that Cardiff council has recently launched a plan to get commuters to walk or cycle? This scheme has been designed with help from Copenhagen and experts there who’ve developed a very successful cycling strategy there. The target is to get commuters in the city out of their cars by 2021—and 60 per cent by 2026. Does the Cabinet Secretary welcome this initiative from Cardiff and think it is very good news for the city?

Ken Skates AC: I do very much welcome this initiative by Cardiff city council. We have some distance to travel before we catch up with some of those Scandinavian countries, but we are on the right path. The key to success is in changing people’s behaviour and cultures. For that reason, I’m particularly pleased that we are investing in the Active Journeys initiative, which is operating in primary and secondary schools across Wales. It’s my understanding that, to date, somewhere in the region of 232 schools across the country have been involved in that particular scheme and more than 30 are in Cardiff. The importance of that scheme is that it creates a change in perception and a change in behaviour amongst people at the earlier stage. We know, with recycling and the change in behaviour that’s accompanied recycling, that if you can convince young people to do things differently, they in turn convince adults and parents. In the next financial year, we’re also going to be making available £2 million for road safety education. The Member will be aware, because it was in Welsh Labour’s manifesto, that we have restated our commitment to improving cycling proficiency, and this fund is designed to do just that. I also fund, the Member may be aware, the travel plan co-ordinators across Wales, who are tasked with working with employers in their respective areas to encourage staff to use alternative forms of transport, or indeed to walk, where a car is not needed. This is complemented by the Cymru Travel Challenge offer, which aims to encourage commuters, again, to switch from their cars to other forms of transport or to walk for short journeys.

Russell George AC: I met with your predecessor, Edwina Hart, last year with regard to Welshpool’s one-way traffic system, along with Welshpool Town Council as well. It was agreed at the time that Welsh Government would undertake some work to assess the options of Brook Street being reverted back from one-way to a two-way traffic system to ease the ongoing issues in the town. I’d be grateful if you could provide me with an update on this.

Ken Skates AC: I’d happily provide the Member with an update. I’m very pleased that we’ve been able to identify additional resource to solve the problems of pinch points across the trunk road network in Wales. But I’m also keen to ensure that, where we can identify solutions to in-town congestion, we implement them at speed. So, I’d be more than happy to take a look at the particular proposal for Welshpool, which, if we can make progress on, I think will complement very much the investment that we’re making in Newtown as well with the bypass there.

Neil McEvoy AC: I declare an interest because I drive on these roads and I’m a member of Cardiff council. I find it incredible that Julie Morgan is talking about plans to reduce road congestion when she supports Cardiff’s local destruction plan, which would put 10,000 extra cars on the road. So, Cabinet Secretary, maybe you can explain and maybe enlighten the public as to how a local development plan putting at least 10,000 extra cars on the road in the west of the city is going to reduce congestion, because building on the green fields, as you plan to do—are you going to say those people are not going to drive into town? Absolutely incredible.

Ken Skates AC: I don’t think the honourable Member should be so disparaging about colleagues in the Chamber. But the important point to make about Cardiff is that we are rolling out one of the most ambitious programmes, in the form of the metro, for public transport anywhere in western Europe. I think that’s something that should be applauded and it’s something that will hugely contribute to removing cars from our roads. I’m also looking at other innovative ways to support the bus network. The Member may be aware that this week I hosted the bus summit in north Wales—although it was a pan-Wales event; again, I’m keen to decentralise wherever I can—and that looked at how we can create a more sustainable bus network across Wales that encourages people to move from their private cars to buses. We know that there are 101 million passenger journeys taken by bus every year, but that number has fallen in recent times. The number of people that are taking journeys on commercial routes has fallen, whilst at the same time community transport usage has increased. There is, without a shadow of a doubt, the scope to increase the number of people who are using buses, and within intensely urban areas such as Cardiff city centre, I think it’s absolutely essential that we look at how we can encourage more people to use buses.

<p>Access to Public Transport for Disabled People</p>

Julie Morgan AC: 5. What plans does the Cabinet Secretary have to improve access to public transport for disabled people? OAQ(5)0116(EI)

Ken Skates AC: We are fully committed to public transport for disabled people that removes barriers to travel, that empowers people and that promotes independent living, rather than inhibits it. I’m also particularly keen to ensure that public transport empowers vulnerable groups to participate in society, and this is a cornerstone of ‘Taking Wales Forward’.

Julie Morgan AC: Thank you, Cabinet Secretary. Does the Cabinet Secretary have any plans to increase the role of community transport in the future, as part of the mix of transport available? Last week, I visited VEST and found that it was overrun with requests from people asking for help to go to day centres and to go to doctor’s appointments, and it seemed to me that there is a crucial role for community transport in the future. So, what plans does he have?

Ken Skates AC: As I just said to Neil McEvoy, I think community transport plays as an essential role within the mix, and we’ve seen an increase in the number of people using community transport in recent times. It’s my belief that community transport plays a particularly important role for people who are unable to access conventional buses or trains, or who may have particular health-related requirements. I want the community transport sector to be part of the solution for my plans for a fully integrated public transport network across Wales. I’m very pleased that we’ve been able to freeze and maintain the bus services support grant at £25 million, which is available to community transport, and I’m very pleased that that fund is being utilised by many of the operators around Wales.

David Melding AC: Can I commend Julie Morgan for raising this issue about community transport? Because for the most disabled people—those that are most vulnerable and least likely to take any sort of journey—community transport is vital. I think it’s fair to say there was a lot of innovation until about 10 years ago when the grants system changed a bit, and it’s not quite been taken forward with the sort of pace that we are seeing improvements, whether actual or planned, in public transport. But there are ways of delivering these services in a very innovative, effective way, but they do need quite a high level of subsidy, and I think those people deserve that type of support from the rest of us.

Ken Skates AC: I couldn’t agree more. I think it’s absolutely essential that we recognise that public transport should be an empowering provision, and that every person in society should expect access to good-quality forms of public transport. The Member might be interested to know that I’ve established an accessibility group to advise me on the new rail franchise, but the group is also able to advise me on other forms of public transport such as community transport. I think it’s essential that we recognise, again, as part of that fully integrated system, that community transport will become increasingly important across communities, not just in more urbanised areas but especially in rural areas where often there are no other solutions available.

Siân Gwenllian AC: The general opinion is that the rolling stock that is used by the current rail franchise in Wales is of a very poor quality and significant investment will need to be put into it to improve the stock, which impacts on the passenger experience. But, in addition to that, by 1 January 2020, the carriages will have to conform to the new rules for accessibility for disabled people. According to the most recent survey, 73 per cent of the Wales and borders carriages would not attain the required standard. Are you confident that it’s possible for 100 per cent of the new Wales and borders franchise to attain that standard by 2020?

Ken Skates AC: It’s essential that the PRM 2020 is met by the new franchise operators. All four bidders are well aware of their obligations that they must meet by 2020. As we are currently involved in a competitive dialogue process with the bidders, I can’t reveal any of the details of what they are offering, but I can assure the Member that we are focused on delivering a transport system that doesn’t just offer quick, reliable transport for the most able, but is also there and capable of meeting all of the current and indeed near future measures that will be introduced.With regard to accessibility for rail users, I’ve mentioned the accessibility group that’s been convened to advise on the next franchise and I’ve also sought agreement—and it’s been given—from each of the four bidders for that group to liaise directly with them over how they can meet the obligations that are going to be there in 2020.

<p>Critical Infrastructure Projects (North Wales)</p>

Darren Millar AC: 6. Will the Cabinet Secretary provide an update on investment in critical infrastructure projects in north Wales? OAQ(5)0105(EI)

Ken Skates AC: Yes. As set out in the national transport finance plan, we are making significant investments to modernise transport infrastructure across north Wales. We are also working closely with National Grid to explore how a third Menai crossing could be utilised to carry power from Wylfa Newydd onto the national grid.

Darren Millar AC: The Cabinet Secretary will be aware that I’ve been very concerned for some time about the vulnerability of the transport infrastructure in north Wales to flooding, particularly around the area in Old Colwyn. The Welsh Government, of course, had some additional resources, capital resources, as a result of the UK Government’s announcement last year—an additional £400 million. What work are you doing with your colleague the Cabinet Secretary for Environment and Rural Affairs to ensure that that critical infrastructure—the A55 and the north Wales railway line—have sufficient protection from the sea? Because you and I both know that those sea defences were damaged significantly in the storm just a couple of weeks ago. They take a pummelling every time there’s a high tide with onshore winds and I’m concerned, very concerned indeed, that if something doesn’t happen soon, there’s going to be some catastrophic failure that could lead to a loss of life.

Ken Skates AC: I was pleased to meet with the Member on Monday in Llandudno Junction to discuss the tidal lagoon proposal and during that discussion we raised the prospect and possibility of a lagoon actually protecting coastal communities. I think it’s really important that I continue to work with other Cabinet colleagues in finding solutions that get best value for money for the taxpayer. In terms of Old Colwyn, the Member is absolutely right; this is a particularly complex project that involves a number of Government departments to work together. I’ve been absolutely clear that, should Conwy council wish to bring forward a proposal for a project that requires funding, I would be more than happy to consider it.

<p>Young People’s Access to Transport</p>

Lynne Neagle AC: 7. Will the Cabinet Secretary make a statement on young people’s access to transport? OAQ(5)0113(EI)

Ken Skates AC: Yes. I remain very keen that there should be a legacy scheme after the current mytravelpass ends on 31 March. My officials have had encouraging discussions with representatives of local authorities and with the confederation of bus operators. I’m optimistic that I will be able to confirm the details of the successor programme very soon.

Lynne Neagle AC: Thank you. That is encouraging, because I was very disappointed that the mytravelpass scheme was not going to be continued, particularly as one of the reasons given to the media was that young people were only using it to travel locally, which, for 16 and 17-year-olds, I don’t think should be particularly surprising. My concern is that young people will be prevented from having access to education, training and youth services. I hear what you’re saying about working with local authorities and the confederation of bus transport, but it is very much my experience locally that bus services are being cut because of the funding pressures on local authorities. I would like to know what evaluation you undertook of this scheme and what decisions led you to the decision to discontinue it.

Ken Skates AC: I should point out to the Member that this was a pilot scheme, and therefore something that we can learn from. And we have learnt from it. The fact of the matter is that uptake was not as high as we would’ve wished, which is why I’m very keen for the successor programme to reach more young people across Wales. I believe it’s something in the region of 10,000 young people who took advantage of the mytravelpass scheme; I would wish to see that number grow far more with the scheme that will emerge, which I’m hoping to announce within the coming weeks.

<p>Vehicle Journeys around Newport</p>

Jenny Rathbone AC: 8. What has the Welsh Government done to collate the starting points and destinations of the 43 per cent of vehicle journeys around Newport of less than 20 miles? OAQ(5)0104(EI)

Ken Skates AC: We have undertaken roadside surveys and postcard surveys at the Severn crossings and we’ve also made innovative use of mobile phone technology to understand trips made in and around Newport.

Jenny Rathbone AC: It would obviously be very interesting for all of us to see this, because, clearly, it’s a crucial piece of information if we’re going to get the modal shift of people with the investment that we’re hoping we’re going to make in the metro. Obviously, there’s a wealth of evidence that people will only shift if there is either improved journey times and/or an improved cost for their journeys. I just wondered if you could say anything more about that, given that you have got the information and we haven’t.

Ken Skates AC: Yes. The Member is absolutely right. Data gathered from vehicles in terms of discovering their origins and their destinations will inform us in terms of understanding how people move around the region. Data collected as part of the M4 project will be used to inform development of the metro, and rightly so, because we need an evidence-based vision for the metro development. Rail ticket sales and other industry data are also an important source of information in planning transport interventions, and will inform the business case and also the design of phase 2 of the metro.

<p>The Productivity of the Welsh Economy</p>

David Melding AC: 9. What measures are in place to improve the productivity of the Welsh economy? OAQ(5)0109(EI)

Ken Skates AC: We are taking forward a range of measures to increase productivity in Wales, including raising skill levels, investing in high-quality infrastructure and also supporting innovation.

David Melding AC: I think skills are key to productivity, and an often overlooked area is the skills of management, particularly middle management. There’s a lot of evidence that that’s a key sector, both in the public and private sectors, and perhaps more initiative needs to be invested there to get the best quality management we can have.

Ken Skates AC: The Member is absolutely right, and I believe this is a subject that Professor Dylan Jones-Evans has been examining very closely recently. We can provide, through the Business Wales service, a mentoring service that drives up the availability of skills advice right across the business community. The Member is also right to say that skills are fundamental in driving an improvement in productivity. We have been conducting, as part of the work on the prosperous and secure strategy, work on sub-regional productivity variances, and what we’ve found is that adverse skills distribution is very much a key factor in lower productivity rates. We’ve also found that lower density of activity, or, if you like, a lack of agglomeration, is also a feature, which explains why productivity rates tend to be higher in bigger cities.So, there are various reasons for productivity not being as high as we would wish, but now that we have the evidence base to take forward a strategy, I am convinced that the strategy will be able to deliver on an aspiration that’s shared across this Chamber to drive up the wealth and prosperity of Wales.

Lee Waters AC: Cabinet Secretary, I was pleased earlier that Adam Price quoted this week’s ‘Llanelli Star’, which reported faithfully what I said in the Senedd last week. Since then, Nia Griffith—the MP for Llanelli—and I have communicated further with steelworkers in our constituency, and we have very real concerns that the deal, which is only possible because of the Welsh Government’s intervention, faces being voted down. Would he echo my concerns to the Tata chair that unless further changes are made, this deal may be lost, and the impact to the productivity and the wealth of the Welsh economy will be significant? Would he also agree that calling for a better deal, and calling for the deal to be rejected, is the world of difference, because that would be irresponsible?

Ken Skates AC: I think the Member is right to draw attention to the fact that encouraging people to vote down—as Plaid Cymru have done—a deal could lead to the collapse of the steel industry. That is in nobody’s interest, whether you are employed as a steelworker, or whether you live in a community or are related to a steelworker, which I am.

I thank the Cabinet Secretary.

3. 2. Questions to the Cabinet Secretary for Health, Well-being and Sport

[R] signifies the Member has declared an interest. [W] signifies that the question was tabled in Welsh.

The next item on the agenda is questions to the Cabinet Secretary for Health, Well-being and Sport. The first question is from Nathan Gill.

<p>The Betsi Cadwaladr University Local Health Board Improvement Programme</p>

Nathan Gill AC: 1. Will the Cabinet Secretary make a statement on the improvement programme for Betsi Cadwaladr University Health Board? OAQ(5)0109(HWS)

Vaughan Gething AC: Thank you for the question. The health board reported against the milestones set out under the improvement framework in November last year, which highlighted good progress. I expect to see continued and sustained delivery of the required improvement outcomes before I can consider removing it from special measures.

Nathan Gill AC: Thank you for the answer. I received an e-mail from somebody in Old Colwyn who was concerned about the fact that their general practitioner is now retiring, and 1,200 of the patients are going to be disbursed amongst different surgeries. Now, it seems to me that what we need to be doing is thinking creatively around this area around GPs retiring, and maybe bringing some of them back out of retirement, or people who are going to be retiring, encouraging them to stay on part-time. One of the major blockages for this is the fact that indemnity insurance can range anything from £5,000 to £40,000 per GP per year. Can the Welsh Government look into this and see if they can find a creative way in assisting GPs to cover these costs in order to cover GPs on the rota?

Vaughan Gething AC: Thank you for the question. There are a range of things we are already talking to the GP and wider primary care community about—that includes what happens when people choose to retire; how patients have an uninterrupted access to a proper primary care service; and the sort of interventions the health board are able to undertake if they are not able to manage a smooth transition to another practice and actually continue. Actually, what Members should take comfort from is that, in each instance where someone has retired and handed back their contract, there has been no break in provision, that every patient has been found a new practice to go to, or that the health board themselves have managed to run a proper primary care service. I recognise the particular issue the Member raised about indemnity insurance. It’s something we have active conversations with the British Medical Association about, and I’m hopeful that we can come to a solution in the near future.

Darren Millar AC: Cabinet Secretary, you’ll be aware of the concerns that have been expressed about the pace of progress at the Betsi Cadwaladr university health board, particularly in terms of progress to deal with some of the mental health challenges in the region. Following the Tawel Fan scandal, quite rightly, the Government put the health board into special measures, and one of the reasons it did so was because of its failure to address concerns about mental health issues. However, there was a six-month delay before the follow-up work, which was promised in the wake of Tawel Fan, was actually commenced. As a result of that now, we are drifting into a longer period. We were told that the work would be finished by March; now we’re told it’s going to be at least until the summer that people will have to wait. No-one’s been held accountable for what happened at Tawel Fan. There are people who are still suspended on full pay, much to the consternation of taxpayers in the region. When can we expect to see the sea change in delivery in terms of mental health services in north Wales, so that people can be confident that they are of a high quality? There’s no mental health strategy yet. We’ve only got an interim director of primary and community mental health care. These are things that should have happened quickly in order that people could get over the past and look forward to the future.

Vaughan Gething AC: I think there are two particular parts to the comments the Member sets out. There is, in fact, a substantive director of mental health services, and he is leading the approach to actually reform mental health services in north Wales. So, you will see engagement over the period of the next few months on that new mental health strategy, which is absolutely needed, because, as a Government, we recognise that mental health is one of the most significant challenges that the health board faces for the future, and it’s probably the one that will take the longest period of time to resolve properly. In many ways, that’s why we set out the length of timescale that we expect the health board to be in special measures. I actually think the new director’s had a significant impact, but it’s important that that continues and is sustained.The second point that I think you’re making is about the ongoing investigation. The health board did the right thing in actually approaching the Health and Social Care Advisory Service to undertake a proper and independent investigation, and what has happened is that that investigation has lengthened and expanded. As they’ve gone through, more families have contacted them and more interviews have been undertaken. My understanding is they’ve already had to review 300,000 pages of documentation and there are more people who still need to be interviewed. So, I think the most important thing is that enough time is taken to do this properly, and I don’t want to set any artificial deadlines for timescales that would actually potentially compromise the thoroughness and the adequacy of the report that we will ultimately receive. However, I do recognise that it would be in everyone’s interest if this matter could be dealt with even more promptly and expeditiously from a time frame point of view. There are people who will want to know what happened, from both the families and individuals themselves to the staff members who are engaged and involved as well. It is in all of our interests that this is done quickly; however, the speed of the investigation should not compromise the ultimate outcome and the soundness of that investigation. But I have been very clear with the health board about what I expect them to do. We also need to think about the oversight and the governance of this as well. So, it really does matter that we get this right, and I hope that Members would support and recognise that.

Llyr Gruffydd AC: The health board, of course, is in special measures and has been for a year and a half, and I agree with many of the points that have been made on the problems that exist. But would you agree with me that there are some more fundamental issues that need to be tackled and would you agree that three specific things need to happen to that end? One we’ve already heard about is that we need more doctors and nurses to respond to demand. The second point, of course, is that much more needs to be done to integrate health and social care services. And, thirdly, we need to reopen beds in community hospitals to facilitate that patient flow from general hospitals, otherwise, of course, we are not going to tackle the fundamental problems.

Vaughan Gething AC: Thank you for the questions. We recognise and we regularly discuss the need for a new staff mix, not just the numbers of staff we have but who those staff are and how they’re used. So, the models of care really matter as well as the numbers of staff we have: doctors, nurses, therapists, pharmacists—there’s a whole range of different people we will need in the health service of the future, working a slightly different way. I agree with you about integration between health and care. That is a clear direction of travel for this Government, and we expect to hear more about that during the course of the parliamentary review and the recommendations that it will provide for us and every party in this Chamber. On your third point, again, we do talk about patient flow, in the sense of those patients who don’t need to go into secondary care, don’t need to go into hospital beds, or into anticipatory care, to keep them where they are, a better relationship with residential care and domiciliary care, as well as primary care and social services, as well as understanding what mix of beds we need and what provision we need. Sometimes, that will be in residential services. It isn’t just about having alternative forms of community hospitals. We need to think about the whole mix that we need, so not setting a particular bar or a particular number on beds. We need an understanding of what our whole system needs, how people are getting to the right place for their care and, crucially, how we return people to their community and their home to continue receiving care, where they still have a need for care that doesn’t need to be undertaken in a hospital bed.

<p>Allied Professionals in Primary Health Services</p>

Lee Waters AC: 2. What plans does the Cabinet Secretary have to extend the range of allied professionals in primary health services? OAQ(5)0108(HWS)

Vaughan Gething AC: Thank you for the question. We expect to see an even more extensive role for allied health professionals as part of the primary care team. Health boards are already extending the role of allied health professionals through their local plans to strengthen primary care, backed up by Welsh Government funding.

Lee Waters AC: Thank you, Cabinet Secretary. I was very pleased to welcome you recently to Kidwelly to visit the Minafon surgery, where, a year ago, when the surgery faced a crisis when the doctors left, working closely with Hywel Dda health board, the range of local Labour councillors and the community, it designed a service where there is a pharmacist, a physiotherapist and other allied health professionals working together, and the service that the patients have has improved immeasurably. What can be done to extend that model to GP services right across Wales?

Vaughan Gething AC: I thank the Member for the question. It was, indeed, a very interesting visit, and recognising there was a real threat about the future of primary care in Kidwelly not that long ago. And it was helpful to see a really challenging but supportive environment from local elected representatives. And, actually, the staff within the practice have kept it going, particularly the practice manager, who really had a significant role to play in keeping that together.And it’s a good and practical example of some of the things we talk about in wider theory—why we need a different team of staff in terms of the mix, in terms of being able to deal with the healthcare needs, of professionals. And, often, that means people get seen more quickly, by the most appropriate professional. In particular, I was really impressed with the pharmacist, the advanced nurse practitioner, and the physiotherapist, taking demand away from GPs. They got to do more of what they need to do, in seeing more complex patients, and those people were actually being properly and safely seen and treated. And it’s been popular with patients too. We heard that directly from the community health council.So, it’s more of this we need to see, not less, in the future, in every part of Wales—not just Kidwelly, not just Hywel Dda, but across the country. That is more and more the future of primary care—GPs at the centre of primary care, with more professionals around them, to properly meet and see and deal with the appropriate needs of their patients, wherever they may be in the country.

Angela Burns AC: Minister, more policy development is recognising that we cannot work in silos and that many people will have co-morbidities, which will exercise the knowledge and skills of all allied healthcare professionals. What discussions have you had with professional bodies representing allied healthcare professionals, in order to determine that the training requirements for these bodies reflect not only the current but also the future needs of our population?

Vaughan Gething AC: I have regular discussions with representative allied health professionals. They are an effective and very professional lobby, I find. And they come to you with a range of evidence to back up the statements they make about the future of the service. They are also a group of people who are very willing to change the model of care, and to say there’s evidence that doing things in a different way will provide better outcomes for patients, and that’s really, really encouraging. They have mentioned to me the potential of looking again at some of the particular requirements. But, most of the conversation I have with them is about the numbers that we have and how those staff are used.You will see in the future of the primary care workforce, in the second half of this year, a particular focus on allied health professionals and pharmacy, and other groups, to understand the numbers of people that we need and what we want to do then to recruit more people, where we know we need more numbers—we are, of course, training more people in a variety of different allied health professions—and also how are the current staff, and how their skills are used. So, I think there’s lot of reasons to be positive about what’s happening, as well as recognising the challenge that does exist. So, I’m happy to continue having a regular conversation with them and other representatives of the primary care workforce.

Huw Irranca-Davies AC: Could I, following on from the question that introduced this, thank the Cabinet Secretary for his visit this morning to Tynycoed surgery in Sarn? And he saw the enthusiasm and the expertise of a wide range of professionals, but not only the GPs, not only the allied care professionals, but social care, healthcare professionals, people involved in social enterprises, people involved in the third sector. And the whole thrust of this was to move away, towards a system where it’s to do with well-being rather than the repair costs further down the river.Does he share my hope, and those of other colleagues here, that these innovative collaborations—like the Abertawe Bro Morgannwg University Local Health Board cluster model—pump primed by Welsh Government funding, will ultimately prove those benefits of keeping people healthier for longer in their communities, reducing the load on our ever-stretched NHS services and wider health services, and potentially delivering cost savings too, by making sure that people are kept healthier longer, rather than washing up into acute, secondary, or even our GP care services?

Vaughan Gething AC: Yes. And it was a particularly interesting visit this morning, for the launch of the cardiovascular risk assessment programme in the Abertawe Bro Morgannwg health board area, not just to meet GPs from around the cluster, but also to meet with healthcare support workers, who are going to be a key part of taking forward that particular programme. It’s a good example of building on what’s already taking place in Cwm Taf, and in Aneurin Bevan as well. There’s lots of learning there about going and understanding part of the population who don’t go to see their GP very often, but are at real risk of acquiring future conditions. So, it is about anticipatory care, and avoiding longer term and more chronic conditions in the future.And I was particularly impressed, not just with the focus on well-being, but really taking forward learning. I want to see that rolled out on a consistent basis. That’s one of the things that, if we’re honest, we haven’t done as consistently or as effectively as we should have done in the past. And there’s a real imperative to do more of that in the future. The other really important message that I took from this morning was that clusters are something that GPs themselves are seeing more and more of the real benefit of—the way they get to work together, the way they do it with other professionals in health and care and the third sector—and the way that we release money directly for them has been a big part of gaining trust within that. Trust is a huge commodity, and I was really pleased to hear that the GPs who were there today recognised that there is a Government here that is willing to listen to them and to act with them.

<p>Questions Without Notice from Party Spokespeople</p>

Questions now from the party spokespeople. Welsh Conservative spokesperson, Suzy Davies.

Suzy Davies AC: Diolch, Lywydd. Good afternoon, Minister. Obviously we welcome the additional £10 million in the next budget intended for social services, but that isn’t ring-fenced, so what reassurances have you had from local authorities that it will be spent on services that commentators in the sector say would be lost without it?

Rebecca Evans AC: The budget this year gave extra allocations to social services. We gave an initial £25 million to social services, £4.5 million to reflect the uplift that we’ve given in terms of the capital limit, and a further £10 million that was specifically in grant form this year to address the challenges that local authorities and the sector are facing with regard to implementing the new national living wage. So, because that £10 million is a grant this year, it does give us that extra oversight.

Suzy Davies AC: My understanding, based on answers to previous questions that I put to you is that the living wage created an issue with the initial allocation of budget, and that the £10 million was to sort of make up for that, at least in some part. So, it’s not actually directly for the uplift in the living wage; it’s for filling the gap that the living wage left, if I can put it that way. You didn’t actually address my specific question about which services were endangered, though. As this extra money was given to meet a particular need, rather than just being a general uplift to the revenue support grant, and was raised in part by increasing the maximum contribution that people pay towards their care, I think, actually, it’s in order for both of us to follow that money and make sure it’s being spent with the intentions you originally had. So, when the sector experts told you that certain services were at risk, which examples impressed you sufficiently in order for you to consider even raising this additional money?

Rebecca Evans AC: The decision to invest further in social care this year is a direct reflection of the discussions that we have had with experts in the field. We held three round tables with local government, with providers and others, in order to listen to the challenges of the social care sector, and work out a way we can collaboratively respond to them. So, Welsh Government is providing extra funding—you’re correct in saying that—but we also require local government to commission services in a cost-effective way and to invest there. Also, there is an onus on providers themselves as well, in order to make social care the kind of career that people want to work in. It’s unacceptable at the moment that there is a third turnover in staff in the sector, and every time a new member of staff has to be appointed, it costs the provider £3,500, with all of the checks and the training and so on. So, it’s incumbent on all of us to work in partnership in order to ensure that we have sustainable and resilient social care for the future.You referred to the increase in the cap on domiciliary care to £70 this year. That will give local authorities an extra £4 million on top of the other funding, to which I referred as well. I think it was a fair time to consider increasing that cap because the cap has been at £60 now for the last two years. So, I think that the increase is a reasonable increase to make.

Suzy Davies AC: Thank you for that answer, and I don’t challenge you on your answer on the rise in the cap on payments towards domiciliary care, but I’m still struggling to find out what exactly it is that this £10 million will go on. What I’m picking up from your answer is that it’s primarily to do with staff retention, and that may well be the case, but that’s what I want to be able to see happening as a result of this extra money coming into the system. I think we probably agree that preventing avoidable reliance on social care is worth while, both to our citizens and obviously for the services that provide that care. In my meeting with members of the Welsh NHS Confederation today, the key players—and they are key players in this, there is no two ways about that—summed up the current situation like this: they said that Wales has the answers for growing demand for more complex social care, but it’s the structure that gets in the way. I heard the Cabinet Secretary’s reply to Lee Waters’s question, and to the supplementaries, about how allied healthcare professionals can be part of this and that complete understanding that they are willing and ready to take part in different ways of working.Do you now have enough evidence about partnership working, pooled budgets and all the rest of it from local health authorities, local authorities and from the third sector even—evidence that is strong enough to start developing policy now on a Wales-wide basis, which is predicated on greater numbers and a greater responsibility for occupational therapists, physiotherapists and other allied healthcare professionals, releasing them from this silo of secondary intervention only?

Rebecca Evans AC: I think the intermediate care fund is providing us with just that evidence. We have a £60 million intermediate care fund, which is really transforming the way that local authorities and health boards work together, including meeting people’s needs. Just this morning, I was in Ystradgynlais, seeing the good work that they’re doing there in terms of bringing together health and social care, and they did include the allied professionals as well. I sat in on one of the team meetings where cases were discussed, and it was absolutely incredible to see how quickly packages of care could come into place when they had all the right people around the table. So, we are gathering that evidence. Our intermediate care fund projects are providing us with information on a quarterly basis and we’re analysing that, looking at what really works. Because we’re starting to get to the point now when we can demonstrate the number of nights saved to the NHS, for example, and we have surveys of satisfaction from people who’ve been recipients of care through the intermediate care fund. I think it’s fair to say that we’ve been blown away by the success that we are seeing in the various projects right across Wales. I’ve visited projects in Swansea, Bridgend, and a couple up in north Wales as well. Although the approaches are different in different places, I think it’s important that different projects in different areas learn from one another. I think that the fact that professionals are freed up to do their jobs and to learn from one another, and not to have these artificial barriers between health and social care, is really making a difference to the care that people receive.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Rhun ap Iorwerth AC: Thank you, Llywydd. My questions are also to the Minister. Pressures on emergency departments in our hospitals have an impact on both sides of Offa’s dyke and have been in the headlines again, and there are many reasons for those problems. But, I want to concentrate on the role of social care. Does the Minister agree that good social care services play an important role in preventing people from having to go to hospital in the first place and allows them to leave sooner?

Rebecca Evans AC: Yes, I absolutely agree that social care has a role to play in preventing unnecessary hospital admissions and ensuring that people can have a step-down service to return home as quickly as possible. We know that staying in hospital for too long is obviously bad for the individual in terms of their health and their well-being, which is exactly what the intermediate care fund is doing in terms of providing those step-up and step-down services. We’re able, as I say, to demonstrate the number of nights saved to the NHS, but behind every night saved to the NHS, obviously, is a story of an individual whose care has been improved as a result of it.

Rhun ap Iorwerth AC: We know, of course, what percentage of our budget is spent on the NHS, but the same attention or prestige is not given to social care budgets. In England, of course, we know that the Conservatives have cut the funding available for social care and the impact of that, I think most would agree, has been clear in terms of increasing the pressure on hospitals. Here, in Wales, the Welsh Government takes pride in the fact that social care budgets haven’t been cut to such a degree as they have in England, but why, therefore, has the number of adaptations to people’s homes declined by 21 per cent since April 2011? Why has the amount of equipment provided for users of services reduced by 15 per cent over the same period?

Rebecca Evans AC: You’re absolutely right to say that we do take a very different approach to the one that we see in England in terms of our support for social services because, of course, the UK Government has abdicated its responsibility for social services in putting the burden on councils to raise council tax to pay for social care locally, which I think is an unfair approach and one that we wouldn’t be seeking to adopt here. On delayed transfers of care, we are seeing improvements in those figures and I think that is the result of the work that we are doing through the intermediate care fund. But with regard to the specifics on why we are seeing fewer aids and adaptations, I couldn’t tell you why we’re seeing that because people should be having their needs met through the Social Services and Well-being (Wales) Act 2014, which does require an individual assessment of each person’s needs, which will include aids and adaptations, and they should be available to the people who need them.

Rhun ap Iorwerth AC: Perhaps the Minister should be trying to find out why those adaptations have been declining and why the equipment has not been going out at rates at which it has in the past because that all has an effect and a knock-on further down the line within our health and social care system.Let me draw your attention to another service that is vastly underappreciated—that of unpaid carers. Last year, Carers UK found that 55 per cent of carers in Wales found that their own physical health had suffered because of their caring duties. That’s the highest percentage anywhere in the UK. The amount of respite care provided in Wales—the number of nights of care provided in Wales—has dropped a staggering 24 per cent since 2011. This has happened at the same time as this and the previous Government presided over a programme, of course, of closing community hospitals, with an overall decline in the number of NHS beds available in Wales of 7 per cent. These community hospital beds, I need not point out, could have provided a smooth transition for patients back to the community, tackling delayed transfers of care, as well, of course, as providing desperately needed respite care for the army of unpaid carers that keeps our system afloat. So, will the Minister now admit that the drive to close community hospitals has been a big mistake and that, in the main, and for the sake of strengthening our social care system, it’s time to start reversing that programme?

Rebecca Evans AC: Well, just to pick up on the comment you made on aids and adaptations, I think that we should be looking at whether people’s needs are being met, not whether or not there has been an increase or a decrease in the percentage of certain aids and adaptations that are being installed. If you have specific examples locally as to where people haven’t had their needs met through aids and adaptations, then by all means please raise them with me.I share your admiration for unpaid carers. They’re doing an absolutely wonderful job across Wales. We wouldn’t be where we are without them. This is why we have committed, as a Government, to introducing and to developing a national respite strategy, because we know that provision for respite locally does differ across Wales. When we listen to carers, they tell us that, more than anything, the one thing that they need and that they want is access to respite. This is why, when we asked the Family Fund to look at the kind of support they offer to families here in Wales, we asked them to focus on respite and short breaks, because these are the things that disabled families have been asking us to focus our attentions on.You’ll be aware as well that we’re currently refreshing our carers strategy, and, again, this is through listening to carers as to what their priorities are. Early priorities that are emerging from those discussions, as you would expect, include respite. They also include young carers, older carers and carers of older people as well.

UKIP spokesperson, Caroline Jones.

Caroline Jones AC: Diolch, Lywydd. Cabinet Secretary, one of our most effective weapons for fighting cancer is population-level screening. I welcome the recent announcement made by the Minister for public health about the move to better methods of screening for both bowel and cervical cancer. However, no matter how we improve the screening techniques, our biggest battle is convincing the public to participate in screening programmes. What plans does your Government have to reverse the downward trend in cervical screening and improve uptake in bowel cancer screening?

Vaughan Gething AC: I thank the Member for the question. As you know, the Minister leads on our population health screening programmes as part of her public health responsibilities. We, too, are concerned about the figures confirming that cervical screening rates have lowered, and we expect there to be more public information, but also conversations between health professionals and individuals about the real benefit of undergoing screening for a range of different potential conditions. On bowel screening, I actually think we will see an uptake because the test is easier to administer. Without going into the details of the old test and the newer test, it’s an easier test to administer, and we expect that we will see a rise in the number of men, in particular, who will undergo that particular screening programme.

Caroline Jones AC: Thank you for that answer, Cabinet Secretary. One area that could benefit from improved screening is prostate cancer. A recent study published in ‘The Lancet’ showed that using multiparametric MRI on men who had high prostate-specific antigen levels increases detection of aggressive tumours, and spares many from the need to have a biopsy and its associated side-effects. What plans does your Government have to roll out this new technique across the Welsh NHS?

Vaughan Gething AC: I thank the Member for the question. Prostate cancer is a particular area of focus, and not just because there is a very active—and I welcome their activity—third sector organisation around prostate cancer, who regularly encourage us to find out more for ourselves and to encourage others to think about the current ways of understanding whether people do have prostate cancer and the potential treatment options. Part of the challenge is that we currently have a less than adequate test for prostate cancer, and it’s part of the uncertainty that goes into that. We are interested in advancing the evidence base for more effective tests to understand whether people have prostate cancer and what particular type of prostate cancer, and the evidence you cite from ‘The Lancet’ is just one of those. We need to understand all of that evidence, and understand how much of that goes into diagnosis and how much goes into screening as well. This is one of those areas where demand and a desire to have a wider screening test—we need to know whether there’s evidence that the screening test is actually the right thing to do, as opposed to different forms of diagnosis where there is a suspicion of prostate cancer. As ever, in this area and others, we will continue to be guided by the very best evidence and the very best return in terms of patient outcomes from any new form of screening or diagnosis.

Caroline Jones AC: Finally, Cabinet Secretary, the holy grail in cancer screening is the development of a reliable testing regime for lung cancer. Cardiff University, in a recent trial, found that the use of low-dose CT scans for lung cancer screening has no long-term psychosocial impact on patients, making it an excellent tool for detecting lung cancer early, when there’s a better chance of survival. Does the Welsh Government have any plans to look at the feasibility of using low-dose CT lung screening for high-risk individuals?

Vaughan Gething AC: I think my closing comments to your previous question still hold. We look at all of the evidence available as to what is an appropriate way of either understanding our diagnosis where there is suspected lung cancer, or potential population screening. But I think, actually, with lung cancer, our biggest challenge is the fact that there is late presentation for lung cancer. It’s a really big concern. In particular, we recognise there is a real differential in terms of the most deprived groups and our least deprived communities, and those who are most likely to present and seek help. That is our biggest challenge, and it’s a challenge that the cancer implementation group has recognised themselves. Clinicians within the service and cancer charities and campaign groups recognise that we need to do more to get people to present at an earlier stage, on lung cancer in particular, when there is a better prospect of people having their life saved. But, as I say, I look forward to the evidence on what we could and should do, and how we then implement that progressively and successfully across the whole service.

<p>Out-of-hours GP Services (South Wales Central)</p>

Neil McEvoy AC: 3. Will the Cabinet Secretary make a statement on out of hours GP services in South Wales Central? OAQ(5)0099(HWS)

Vaughan Gething AC: I expect health boards in South Wales Central to provide safe and effective out-of-hours services. This includes ensuring that all patients are dealt with within a clinically appropriate time.

Neil McEvoy AC: Okay. The problem is—and this comes from people in the service—that there have been times over the last 12 months in Cardiff when there has been no doctor available at all in the out-of-hours general practice service. What can be done to make sure that that doesn’t happen in future?

Vaughan Gething AC: Thank you for the question. I’m aware that there were in two occasions, one in August and one in December, when there was no GP available for a limited period of time for part of the night. What actually happened to make sure that the health board could provide a proper service was that there were other health professionals, and there was call-on support from neighbouring health boards, too. The challenge is across the country, in varying degrees. For example, Cwm Taf health board have been much more stable and secure, and they’ve got greater GP numbers going into their service. Cardiff and Vale held another recruitment day in the middle of this month, and they’re hoping that there will be more GPs coming into the service. It is something about how we make the whole model more sustainable as well. It isn’t just a GP out-of-hours service. It is about how we understand all of the needs. For example, 7 per cent of the calls over the last month have been on dental issues—and that’s something I’ve got particular sympathy for right now—but we do need to see the whole range of professionals covering and doing that. That should make it more attractive for GPs to undertake their part of the service. In many ways, it’s a similar issue to the earlier questions and discussions we had on the wider primary care team. We need a wider team within out-of-hours to make sure the GP’s part of the role is both interesting and attractive for GPs to undertake it, so that they provide the right care and make the right decisions that only they can make as part of the out-of-hours service. But it’s definitely something that is on my radar, and I expect to see further improvements over the rest of the year.

Andrew RT Davies AC: Cabinet Secretary, you talked about making the service more sustainable, the GP service and, indeed, the out-of-hours service. Obviously, the backbone of that is having doctors on the ground who can perform the service when it’s required. I heard, in a previous answer that you gave to Nathan Gill, about the insurance, and indemnity insurance in particular, for doctors who are coming to the end of their career who might wish to practise part time and could offer this service back into the NHS, thus alleviating some of the staff pressures. Are you going to bring forward a national indemnity insurance scheme, such as is available in other parts of the UK that is paid out of the NHS risk pool? This would go a long way towards actually tapping into that huge resource of retired doctors who would wish to continue to practise but, because of the cost they face in insuring themselves, it is just not financially viable for them to do that.

Vaughan Gething AC: I indicated earlier, as you will have heard in my response to Nathan Gill, that we’re having active conversations with the BMA about trying to resolve the issue of indemnity. It’s a particular area of concern for them and the whole GP community. It isn’t just an issue about the end of a career, either—it is something running through the lifetime of a GP’s career, as indemnity costs are rising. I’m not going to spike those conversations by trying to talk halfway through about the range of options there are. But, we’re considering a range of options with the BMA, and, as I said, over the coming months, I’m hopeful we’ll be able to bring forward a proper proposal that we will have worked through in partnership with the BMA. Again, that’s the point—we want to work in partnership with our GPs and the rest of the healthcare community.

<p>Accident and Emergency Admissions</p>

Jayne Bryant AC: 4. What assessment has the Cabinet Secretary made on the progress to reduce accident and emergency admissions? OAQ(5)0102(HWS)

Vaughan Gething AC: Thank you for the question. We are committed to reducing accident and emergency admissions through a number of initiatives, including Choose Well, NHS 111 and a range of falls response services. Health boards and the Welsh Ambulance Services NHS Trust are supporting these and similar initiatives in order to ensure that the service operates at maximum efficiency.

Jayne Bryant AC: Thank you, Cabinet Secretary. Several of my constituents have contacted me recently to praise the falls prevention service currently being piloted in Aneurin Bevan health board. Launched in October, this service has helped 183 out of 229 emergency calls to get back to their feet without having to be taken to an accident and emergency department. Not only does this prevent hospital admissions, but the team also conducts a home assessment to prevent further falls in future. Can the Cabinet Secretary keep a keen eye on the evidence and the results of the pilot in Gwent? What more can be done to prevent people being admitted to hospital following a fall when other action is more appropriate?

Vaughan Gething AC: I thank you for the question and, in particular, for highlighting one of those pilots that we are actively looking at. I was also pleased to see that it was highlighted in an ITV Wales report previously as well—that work with the Welsh Ambulance Services NHS Trust, and how their staff are used in a way that avoids emergency hospital admissions and avoids emergency ambulances being sent out as well. It’s about the smarter use of all of our resources, and that’s something that we really do have to do more of now and in future—it’s people in their individual homes, but also people in residential care.We also have a range of pilots—for example, some involving the fire and rescue service in Wales as well. So, there’s a programme of different pilots in different parts of the country. We want to assess and understand what those are, and that will be undertaken through the emergency ambulance services committee. We then expect to learn from those and understand how much more, progressively, they can be rolled out across the country—what evidence works and what’s appropriate in each part of Wales, and then go out and do that successfully. Even while these are reducing the number of admissions that would otherwise come into an A&E department, we do know that we’re still seeing a rising tide of numbers coming into our departments. So, more work on this front is required, not less.

Mohammad Asghar (Oscar) AC: Welsh Government targets say that no patient should wait longer than 12 hours for treatment in an accident and emergency department in our hospitals. However, figures show that the number of patients waiting longer than 12 hours for treatment was 31 per cent higher in December 2016 compared to the same month a year earlier. This is in spite of a 5.5 per cent drop in admissions in our hospitals. What reason can the Cabinet Secretary give for this increase in waiting times when admissions really have fallen in our hospitals?

Vaughan Gething AC: I thank the Member for the question. Actually, we’ve seen an increase in the number of people going into hospitals and in admission rates. The challenge for us is, though, not just accepting that far too many people do wait too long, but what we’re able to do about them. That goes back, again, to previous questions about what we do to keep people out of hospital successfully and what we do to actually recognise the fact that we do have an older and broadly sicker and poorer population than England itself. That means we’re more likely to see people who do come in in the winter time in particular who will need to be admitted. How do we make sure that those people actually have a good patient experience when going through and receiving care in our hospitals? There’s no point pretending that this is an easy challenge to resolve, but it is why we do need a whole-system response—not just the front door of a hospital, but through the whole hospital system, people taking responsibility, and at the front end and at the back end with social care and primary care as well. So, I’m certainly not complacent about the challenges that we face, and I expect Members will continue to ask me a question until we see a fall in the number of 12-hour waiters that continues and is a sustained drop. Because I recognise there is unlikely to be a great patient experience for somebody who waits that long before they’re seen through to their discharge.

David Rees AC: Cabinet Secretary, one of the ways to actually reduce the pressure on A&E units is to look at how the minor injuries units can be used effectively. Now, in Neath Port Talbot and in Singleton at the moment, there is consultation going on about reducing the hours, but part of the problem is the staffing and resourcing of those units. What action is the Welsh Government taking to actually improve the training of advanced nurse practitioners so that we can deliver MIU units that will work effectively, take pressure off A&E, allow patients to go through A&E and major units faster, and therefore also allow patients to be seen within hours rather than perhaps longer hours? And, from personal experience, I know that feeling.

Vaughan Gething AC: Thank you for the question. You’re right to point out that our minor injuries units around the country have a very good record of seeing people quickly, seeing, treating, discharging, or arranging for them to be admitted if that’s required. They are led, in most instances, by advanced nurse practitioners, providing high quality care and able to make decisions that people might think you would need a doctor for. Now, part of the challenge is how we understand what’s sustainable in that way, because you’re right in that some of those units have very small numbers of people attending at various hours in the day, and so health boards will need to understand properly how to make the best use of their staff to meet the demand that exists. There is something to do also about minor injuries streams within major units as well, and, if we get that right, we’re more likely to see a quicker turnaround, not only for people in that particular unit within a hospital, but how we understand how we direct through to the right part of the service. So, again, it goes back to having that whole-system approach and understanding what we need in our minor injuries units, where those should be, what the evidence is for them being at the right time and the right place, but also there is still improvement we do need to see within the major units for that minor injuries stream.

<p>Alcohol Misuse</p>

Joyce Watson AC: 5. What is the Welsh Government doing to help reduce alcohol misuse in Wales? OAQ(5)0106(HWS)

Rebecca Evans AC: We’re investing almost £50 million a year in our substance misuse agenda, which includes taking a range of actions to help reduce alcohol misuse in Wales. Details are set out in our latest substance misuse delivery plan for 2016 to 2018.

Joyce Watson AC: I welcome that, but alcohol is ubiquitous in our society—it’s glamorised on tv, it’s promoted as something that you have to have in order to relax, or even to socialise. It’s advertised in sporting events, billboards, bus shelters, and magazines. Bearing that in mind, it’s not surprising that, based on alcohol sales, Public Health Wales have reported that 75 per cent of the Welsh population drink more than that which is considered safe to do so. I understand that the last Welsh Assembly Government were hoping to introduce minimum unit pricing for alcohol as a way of helping to reduce alcohol consumption in Wales, but I understand that we may not have, under the new reserved model, the power to now legislate. So my question is, first of all: do we have the power to legislate? If we don’t have the power to legislate, what other ways are we planning to help reduce alcohol dependency and abuse even further?

Rebecca Evans AC: Thank you for the question. We do currently, under our existing settlement, have the power to legislate, but, unfortunately, despite numerous arguments made to the UK Government, this is one of the powers that they have sought to remove from the Assembly for the future—but we do still very much support the introduction of minimum unit pricing as an additional lever in order to reduce alcohol-related harm, and we’re actively considering the need to bring forward legislation on this matter. It is part of a wider suite of measures that we are taking. For example, our area planning boards are doing some great work locally, and, in Newtown, in your area of Mid and West Wales, tackling under-age drinking is really important—and we’ve invested there by supporting the development of a community alcohol partnership, which is bringing together local stakeholders, trading standards, police, schools and alcohol retailers, in order to support young people in particular to avoid having a harmful relationship with alcohol.

Paul Davies AC: Minister, you may be aware of Alcohol Concern’s Communities Together project in north Pembrokeshire, which will be hosting a conference in March to learn more about how local communities can actually reduce alcohol harm, and how we can develop healthier relationships with alcohol. Do you agree with me that projects like this are a great way to promote healthier living, and can you tell us what the Welsh Government is doing specifically to promote and encourage these types of projects across Wales?

Rebecca Evans AC: Well, partnership working, as you describe, is absolutely essential, because there are so many parties involved in terms of helping people who already have an unhealthy relationship with alcohol stop drinking, but also to promote responsible drinking as well. The community alcohol partnership, which I’ve just described to Joyce Watson, is one example of how we’re doing that. In December, as well, I published our new night-time economy framework for Wales, and the purpose of that is really to provide a structure for all key stakeholders in order to aid the development and preservation of sustainable, healthy, and safe night-time economies across Wales as well. And, again, that’s about bringing partners together to address these issues.

<p>Hospital Waiting Times (South Wales West)</p>

Caroline Jones AC: 6. What actions are the Welsh government taking to reduce hospital waiting times in South Wales West? OAQ(5)0114(HWS)

Vaughan Gething AC: I expect health boards to continually improve access to services, and reduce waiting times across the full range of services provided. Health boards should do so in accordance with their own integrated medium-term plans, including the measures set out in the clinician-led planned care programme.

Caroline Jones AC: Thank you, Cabinet Secretary. Wales spends significantly more on health per head than they do across the border in England. However, this has not led to significantly better outcomes. Welsh patients are generally waiting longer for treatment than English patients—twice as long for a cataract operation and nearly three times as long for a hip operation. Can you explain why, Cabinet Secretary, we are not as efficient when it comes to health spending?

Vaughan Gething AC: There’s a range of different points to make in response to the question. The first, I’d say, is that actually you’re talking about waits, and that doesn’t necessarily translate into outcomes. Clinical outcomes for patients in Wales are generally very good, and we compare favourably to many parts of England in that regard. However, I do recognise that some people wait too long. That’s part of the point of the planned care programme: to make sure that we do something both to improve the quality, because quality is an important driver for improvement in our system, and it will remain so, but also we want to reduce the length of time that people can expect to wait. I fully expect that, by the end of this financial year, when we get to the end of March, our figures will see another improvement on waiting times within the service here in Wales, but, on some areas, we need to recognise there’s much more that we need to do. Hip surgery is one example. We compare in a way that I do not think is acceptable, but, on a range of other things, for example on kidney transplants and on heart operations as well, we’ve done remarkably well over this last couple of years, and we’re ahead of England in that regard. So, there’s a rounded picture here to recognise and to honestly reflect on areas where we outperform England and those where we need to do better—not simply because of a comparison with England, because it’s the right thing to do for our service in balancing the time people wait with the quality of that intervention and the outcomes that our patients do receive.

Jeremy Miles AC: In a report in January 2015 into NHS waiting times for elective care, the Auditor General for Wales spoke of the Pareto principle, which calculates the number of bed days taken up by individual patients, and discovered that 5 per cent of patients use 51 per cent of bed days, and also discovered that that calculation wasn’t widely used by health boards generally. I wonder what conclusion the Cabinet Secretary reaches in relation to that and whether he feels that principle would be an important principle for health boards to take into account.

Vaughan Gething AC: Yes, I think it’s a really important point about the detail and the data that we do have available to us and how they should be used to drive improvement. Those data should show, actually, for that small number of patients, an improvement around those people could release lots of bed days to make sure other people come through the system and receive care in a more timely manner. We need to understand what is the issue around that small cohort of patients and why they take so long. Is it about complexity, are there more improvements we can make system-wide, is it about clinician-to-clinician improvement as well? So, we always need to understand what the data tell us about that problem and then to understand what the answer to that is, and then to understand what times we expect to see improvement within. Again, it’s why I go back to this: the planned care programme isn’t an optional extra for health boards, it is what I expect them to deliver, and understanding data and understanding clinical agreement and leadership across the country on improving a whole range of these areas, in orthopaedics and ophthalmology in particular, where there are large numbers of people who are waiting—large numbers for whom we can improve their experience and we can also do something about their outcomes, too. So, I’m very interested in seeing that evidence properly deployed by health boards and demonstrating the improvement we all expect to see.

Suzy Davies AC: Yesterday, Care and Repair told me about their warm homes on prescription scheme, which uses the local intelligence of health and care professionals to help identify people at risk of health decline due to inadequately heated homes, and then they intervene to help with more efficient heating. If it works, it will reduce the number of people needing hospital care, which will include elective care for certain chronic conditions, and, of course, reduce the number of people experiencing delayed transfers of care as well. Now, the scheme’s funded from Welsh Government’s housing budget and is a good example of a non-health budget being used to solve a health problem. If it’s successful, will it continue to be funded from the health budget or will this sort of spirit of cross-portfolio budgeting be tested over much if this pilot is extended beyond the trial period that it’s now being used for?

Vaughan Gething AC: I’m very grateful to her for highlighting this particular use of Welsh Government money to deliver improvements for people in their housing and their health. We recognise, in housing, in education, and in a range of other areas, there are significant links to the health of the nation too and how they impact across each other. We always need to understand why something has been successful and to what extent we can roll it out on a wider basis. So, I’m particularly interested in understanding the lessons from the particular pilot we funded and then what that means for how we use money across Government. Sometimes, we can get—whether in this party or in others—a bit too focused on where the sums of money are actually allocated rather than what they deliver. I am interested in the quality that we deliver, and the outcomes we deliver, for people. That’s why we’ve invested more money in the budget in improving the quality of housing and the numbers of houses that we have as well. We recognise there’s a real impact in quality across a whole range of things and not just about the housing factor as well. So, I expect that you’ll see from Government our own assessment with health boards and with housing partners of the success or otherwise of that scheme and what we’ll then want to do in the future.

<p>Cancer Waiting Times</p>

Michelle Brown AC: 7. What progress is being made by Betsi Cadwaladr University Health Board in respect of cancer waiting times? OAQ(5)0105(HWS)

Vaughan Gething AC: Cancer performance at Betsi Cadwaladr University Local Health Board remains at higher levels than in other health boards in Wales. The latest figures for Betsi Cadwaladr show nearly 99 per cent of people meeting the 31-day measure and nearly 92 per cent against the 62-day measure. Cancer waiting times will, of course, remain a key priority for me.

Michelle Brown AC: As has often been pointed out in this place and elsewhere, there is still a long list of patients who have been failed by Betsi Cadwaladr during the treatment of cancer and other illnesses. No clinician would wilfully neglect or let down a patient in their care. That these errors have happened and are continuing to happen is down to mismanagement by the local health board. What will the Cabinet Secretary say to those families who have been let down by Betsi Cadwaladr and who are perhaps now waiting for delayed results and, like a constituent of mine, for the outcome of delayed treatment, frightened that their loved one may not live as long because their cancer may have spread?

Vaughan Gething AC: Thank you for the question. I don’t quite share your reflection on the whole picture. As I’ve indicated, Betsi Cadwaladr do extremely well when it comes to waiting times for cancer. The challenge is, anyone who waits too long—. Even if you’re seen within time it can be an anxious process and that has a real impact on the individuals and their families. If you’re seen out of that time, of course, people are more worried about the potential impact on their outcomes. We know there have been ombudsman investigations that indicate there have been times where the health board have not acted in a way in which they could and should have done. It’s important that, in recognising the high quality of care that is delivered and the good performance when it comes to waiting times, we don’t avoid looking at those areas where the health board could and should improve as well. There’s learning to take from that, and I understand that if you’re one of those families where you feel the health board have not acted as they could and should have done it won’t really matter to you if the general experience, the overwhelming experience, of people is an entirely different one. There is a real point about learning and accountability for that and in our own drive for improvement and the health board’s one too. So, I expect Betsi Cadwaladr, as in fact every other health board, to properly learn when mistakes are made and then to do everything they could and should do to make sure they don’t occur in the future.

<p>General Practitioners</p>

Mark Reckless AC: 8. Will the Cabinet Secretary make a statement on what proportion of GPs are directly employed by local health boards? OAQ(5)0103(HWS)

Vaughan Gething AC: Only 15 general practices across Wales are being directly managed by local health boards. My overriding concern is that health boards ensure that the whole primary care team, of which GPs are a crucial part, deliver care that meets the needs of the population that they serve.

Mark Reckless AC: I’ve seen in my own area of south-east Wales in several Valleys communities that the Aneurin Bevan Local Health Board has used direct employment of GPs to improve availability and to attract people to those areas, potentially for a few years rather than for their whole careers. Is this something that the health Secretary sees as to be deployed on a sort of case-by-case basis, or is it the policy of the Government to try and shift provision over time and increase the proportion of directly-employed GPs compared to independent practitioners?

Vaughan Gething AC: I’m not at all worried about whether people are directly employed by the health board or in independent practice. The independent contractor model accounts for about 95 per cent of all general practitioners within the country. I’m interested in seeing the quality of that care improve. On what I said earlier about clusters, it’s really encouraging that GPs are taking more ownership of their future with the whole primary care team. And it’s for them to determine whether they think there are new and additional models—they can still maintain independent contractor status—that will deliver the quality of care and the spread and the reach of care that we want to see, whether that’s the federated model in Bridgend, whether that’s a community interest company such as Red Kite in Brecon, or whether that’s different sorts of models that exist. We’re understanding those through listening and working with the profession. That’s why the ministerial taskforce is really important. It isn’t just about a recruitment campaign; it is about understanding what we can do to enable and empower general practice to make an even bigger difference, to make their jobs even more interesting—and the role of allied health professionals and others around it. Crucially, what this Government can do is to properly listen. That’s why the choice I made on relaxing the quality and outcomes framework to the end of March has been welcomed by GPs. Again, GPs this morning, when I was with Huw Irranca, made a particular point of saying ‘thank you’ for that decision. It’s been a real help to them. It shows that, when this Government listens, it makes a difference to GPs now, and that sort of relationship I believe will be crucial to attracting more GPs to come here to train, work and live in the future.

Thank you, Cabinet Secretary.

4. Statement by the Llywydd

Before we move to the next item, it is my pleasure to announce the result of the legislative ballot held today. Dai Lloyd may seek the Assembly’s agreement to introduce a Member Bill on the protection of Welsh historical place names. Congratulations to Dai Lloyd and the best of luck.

5. 3. 90-second Statements

Item 3 is the 90-second statements. Vikki Howells.

Vikki Howells AC: Diolch, Lywydd. My first 90-second statement just before Christmas focused on Guto Nyth Brân and the Nos Galan. With the sad death of Bernard Baldwin MBE just days after the 2016 Nos Galan, it is only fitting that I use a second statement to pay tribute to Bernard’s legacy as creator of Wales’s most famous racing event. Born in Barry in 1925, Bernard trained as a teacher and took up a post in Mill Street school, Pontypridd. A keen athlete, Bernard was Welsh junior mile champion and spent nine years as secretary of the Welsh Amateur Athletics Association, representing them in the UK and around the world. He received an MBE in 1971 for services to athletics. Bernard also set up a range of athletic events. Most famous is the Nos Galan road race, with its commemoration of Guto Nyth Brân and crowd-pulling mystery runner. But Bernard also established the Taff Street dash, the Cardiff to Mountain Ash two-man relay and too many others to list, but all of which aimed to bring athletics to the people. Bernard wrote prolifically on athletics and his adopted home of Mountain Ash, and was given the freedom of the borough by RCT in 2014. Crowds attended his funeral at St Margaret’s church last Wednesday to celebrate Bernard’s memory and pay tribute to a life well lived, full of passion and service to the community. Bernard’s ashes will be scattered on Guto’s grave at Llanwonno Church and through the Nos Galan, Bernard’s memory will live on.

Russell George.

Russell George AC: I’m delighted to have this opportunity to pay tribute to David Pugh, a former mayor of Newtown and celebrated local historian, who sadly passed away last week. David Pugh was a leading local historian for many decades, instrumental in establishing the Newtown history group in 1995 and its journal ‘The Newtonian’, both of which continue to flourish today. Best known for being seen with his camera recording buildings for historic records, there is now a 64-volume quarterly journal called ‘The Newtonian’, which comprises a library of over 28,000 references and 26,000 photographs of the town and its people. Thanks to David Pugh’s sustained commitment and determination, ‘The Newtonian’ has undoubtedly provided an authoritative record of the town’s history for future generations. David’s legacy is that the recorded history of Newtown will now be around for years and years to come. In establishing the Newtown history group, he received the Queen’s Award for Voluntary Service in 2013, and he was also a prominent member of the Newtown and District Civic Society. David was a longstanding member of the Labour Party and his wife, Anna, told me this week that when David went to vote, he always wore red socks. His contribution to civic society in Newtown has been outstanding, and he will be missed by me and the Newtown community.

6. 4. Statement by the Chair of the Children, Young People and Education Committee: Future Inquiries and Engagement Work

The next item on our agenda this afternoon is a statement by the Chair of the Children, Young People and Education committee and I call on the committee Chair, Lynne Neagle.

Lynne Neagle AC: Thank you, Llywydd. I welcome this opportunity to update Members on the work of the Children, Young People and Education Committee. As Chair of the committee, I am delighted by the progress made in scrutinising key areas of policy and legislation over such a short period of time.

The Deputy Presiding Officer (Ann Jones) took the Chair.

Lynne Neagle AC: Over the summer, we consulted on what our committee’s priorities should be. I was pleased to see diverse and detailed submissions from nearly 90 organisations and individuals from across Wales. This led to the committee embarking on two inquiries that stakeholders had identified: statutory advocacy services for children and young people and educational outcomes for Gypsy/Traveller and minority ethnic learners. We have finished taking evidence on both of these subjects and will be reporting soon.Looking further ahead and more strategically, our committee, in the process of its planning, set out principles and ambitions for our work over the fifth term of this Assembly. Underpinning everything will be the involvement of children and young people. Through our work we will ensure the views and experiences of children and young people are captured in a useful, sensitive and constructive way.In our snapshot inquiry into youth services in Wales, more than 1,500 people gave us their views on the services they use. Their input formed an essential part of our findings and recommendations, which were published in December. The feedback from young people was incredibly clear: when youth work provision disappears from a young person’s life, the impact is considerable. These services are often a catalyst to help them develop skills and confidence and make better choices in their lives.It continues to be essential for us to work with stakeholder organisations, carers, teachers and parents. I am wholly committed to ensuring we are an outward-facing and engaging committee. During our Stage 1 scrutiny of the additional learning needs Bill, our Members will be hosting events with parents and carers in north and south Wales.I am also pleased to inform Members there will be a series of workshops taking place for young people with additional learning needs. This will be an important part of our work scrutinising the ALN Bill and I look forward to seeing the views of young people guiding our work. We will also be holding a conference for practitioners and stakeholders working with children and young people to tell us their views on the Bill. It would be remiss of me not to thank TSANA and SNAP Cymru for their fantastic partnership working with our committee over the past few months. This partnership has allowed us to meaningfully engage with those who will be directly affected by the legislation. Our partnership work and outward-facing approach through the course of this legislative scrutiny will ensure service users’ needs are at the heart of our work and scrutiny of the ALN Bill will form the substantive part of our work until the end of spring. Llywydd, the committee members and I are committed to undertaking work that will make a substantial contribution to improving the lives of children and young people in Wales. In one of our current consultations, we are examining the importance of the first 1,000 days of a child’s life from pregnancy through to the second birthday. This formative time is a critical part of a child’s upbringing and sets the stage for intellectual development and lifelong health. The Committee will consider the extent to which Welsh Government policies and programmes support the early parent role in the first 1,000 days and, crucially, how effective these are in supporting children’s long term emotional and social capabilities and development. This important inquiry will, I hope, set the stage for a major national conversation about how we can really set our future citizens up for happy and healthy lives.The committee is seeking input from teachers and other education professionals for our inquiry into teachers’ professional learning and education. The Welsh Government is reforming the way new teachers are trained before they qualify and also their ongoing professional development throughout their careers.These professionals are sometimes locked into inflexible schedules and due to capacity and planning issues often cannot get the time to further themselves professionally. This cannot continue given the ongoing changes to the Welsh education system, so we will be looking specifically at arrangements for continuing professional development for the current workforce; the role of initial teacher education; and the sufficiency of the future education workforce. As part of our consultation, we will be working with the Public Accounts Committee to jointly engage with the teaching profession as part of their work into consortia.Members will be pleased to hear that our committee will not just be undertaking a series of fixed pieces of work, but also ensuring that ongoing scrutiny of developing areas of policy takes place. To that end, we are continuing—[Interruption.]—sorry; it’s a very bad time to develop a cough. To that end, we are continuing to closely examine the implementation of both the Donaldson and Diamond reviews. This will play a crucial role in delivering success of the important reforms being put forward. Linked to our ongoing scrutiny of curriculum reforms, we will be examining more closely Wales’s performance in PISA and examining exactly how curriculum reforms will impact on our international standing. Child health will play a big part in our work over the coming years. I very much look forward to working with organisations like the Royal College of Paediatrics and Child Health and welcoming the Welsh Government’s chief medical officer to the committee in March to outline his vision for improving child health. Members of the committee are incredibly passionate about the quality and provision of mental health services for young people. The committee has already undertaken scrutiny of the Cabinet Secretary for Health, Well-being and Sport, and I am sure that he is aware that we will be continuing to focus on this vital area. The committee will continue to examine the support available to young people in crisis, and in particular delays in accessing child and adolescent mental health services, as well as the support available to children and young people who do not reach the threshold for specialist services. The youth parliament initiative being led by the Llywydd is a genuinely exciting moment in the history of the Assembly. Not only is it one that should create meaningful and long-lasting ties between schools, young people and the Assembly, but it is a true recognition of the value children and young people have in our democracy. I want to offer our committee’s full and unwavering support to the establishment of the youth parliament, and I look forward to us playing a full role in getting it off the ground. In closing my statement today, Llywydd, I would like to thank the young people, carers, parents and experts who have readily contributed to our broad remit of work since the establishment of the committee. I hope that, over the fifth term of this Assembly, the Children, Young People and Education Committee will be a real conduit for the voices of young people to shape policy and legislation in Wales.

Darren Millar AC: Thank you to the Chair of the committee for her statement. Can I put on record what an effective Chair she has been during her tenure so far, as Chair of that committee—bringing the committee together, enabling us to work in a way where there is consensus around the table so that we can maximise our impact? I want to pay tribute to you, Lynne, for your work and your commitment and dedication to the task.As the Chair has already said, there’s been a great deal of discussion and debate around the table as to where the emphasis of the committee’s work ought to be. Very early on in those discussions, we determined, as a committee, that we would continue to pick up on those issues that were legacy issues from former committees. I think it’s really important that all committees in the Assembly get smarter about following up on recommendations and work that they’ve done in the past. The Chair has touched on a number of these, including our follow-up work on Donaldson, and there are others, of course, on children and adolescent mental health services, neonatal care and a whole range of issues that have been the subjects of pieces of work in the past. I’m very pleased that the Chair has put on record her determination to make sure that those are continuously back on the agenda of the committee, so that we can hold the Government and other stakeholders to account for their delivery and promises on those issues. I was very pleased that one of the first pieces of work that the committee has done has been on this whole issue of advocacy for children and young people. We know that there’s been some inertia in recent years in trying to get to grips with this problem and to have a proper fully functioning service across Wales for children and young people that is equitable in terms of access, and I’m very pleased that, even though that report is yet to be published, it’s already had an impact in encouraging the Government, and local government as well, to get together and move things forward significantly. And I know, in terms of the work that we’re doing on Gypsy/Traveller and ethnic minority grants in education, that that work also is drawing attention to something that has not received a lot of attention, frankly, in recent years, and it’s important to shine a light on these particular issues.I have to say, I’ve been disappointed with the engagement, sometimes, of the Welsh Government with some of our inquiries. We’ve done a really excellent piece of work, I think, on youth services and youth work around Wales. And it has been disappointing that the Welsh Government has, perhaps, been making decisions before the outcome of our work has been published—sometimes rash decisions, which it’s then had to row back from. And I think that there’s a lesson there for the Welsh Government.We have a role to play as parliamentarians in the Assembly, helping to contribute to shape the work that the Government does, and I think we’ve got a very useful contribution to make. So, that has been a little bit disappointing, and I was very pleased that the Chair has reflected very well the strong feelings of the committee when things have gone awry, to bring things back on track, in terms of that very important relationship.I think it is important also to note the commitment that the Chair has given today to working very closely and carefully with children and young people, to make sure that their voices are heard regularly in the committee’s programme of work. We did undertake some outreach work as part of our youth services inquiry, but, of course, the Additional Learning Needs and Education Tribunal (Wales) Bill provides us with further opportunities to do just that. And the Chair is quite right to raise the fact that, when the National Assembly has a youth parliament for Wales, which it is able to work collaboratively with, that gives us another forum, which can be usefully used to ensure that children and young people’s views are brought into our work.So, I haven’t got a series of questions for the Chair, I’m afraid, other than to say, ‘Keep up the excellent work.’ I’m very pleased with the start that’s been made, and you’ve certainly got my party’s commitment to work collaboratively with you, and other members of the committee, to ensure that we do an effective job.

Lynne Neagle AC: I don’t know what to say, other than ‘thank you’. [Laughter.] Thank you, Darren, for those kind words. Can I just say that I am very, very keen for the committee to work together as a team? We had an excellent strategic planning day, and it was very apparent that we all genuinely want to make a difference to the lives of children and young people, and I hope that we will be able to carry on in the vein that we’ve started in, and do that. Am I meant to respond to the other points?

If you want to. But, as the Member said there were no questions, it’s entirely up to you.

Lynne Neagle AC: Okay, thank you.

Llyr Gruffydd AC: Well, can I thank you for your statement, and align myself wholeheartedly with the comments made earlier about your role in fulfilling your capacity as Chair? And I agree wholeheartedly with the contents of your statement. But I offer a few comments—and questions—not maybe on a particular inquiry, but certainly on a thematic level.Now, I’m particularly keen for the committee to examine the opportunities for the Welsh Government to transition more decisively to a preventative approach to its work, in terms of investment and policy, across, of course, the breadth of policies relating to the committee. Now, the Welsh Government, in fairness, is increasingly talking about that, moving in that direction, and especially the Cabinet Secretary for Communities and Children here, who, in fairness, has been quite keen on this, to say the least, and I welcome that. But do you agree with me that more could be done to implement and accelerate a move in that direction, and what do you believe the committee can contribute, to encourage the Government to move, increasingly, in that direction?Now, another key area of course, I believe, is to contribute to achieving greater parity of esteem between vocational and academic education and qualifications. And I hope that this can be one of the big legacies of this Assembly, certainly in terms of a longer-term approach, and certainly it’s one we should be approaching, in my view—or pursuing, I should say—as a committee. And I’d be interested in hearing your views about how you think we can most effectively try and do that.Thirdly, on a less positive note, in relation to our inquiry on youth work, and we’ve already heard reference to it—and I would declare an interest as one of the honorary presidents of the Council for Wales of Voluntary Youth Services—could I ask whether you do share my disappointment, having written to the Minister for Lifelong Learning and Welsh Language three separate occasions, that we’re still waiting for answers to six pretty direct, pretty straightforward questions about the way the decision was made around the funding of CWVYS? The first letter was sent in early November, a subsequent letter in December. We’ve been forced again to write this month, and, of course, we’re still waiting for answers. If the committee is to fulfil its role in scrutinising the Welsh Government, in holding Ministers to account, then such evasive responses, which make no effort in fact to answer the questions that we’ve asked, from the Minister, not only obstructs our work but is, in my view, wholly unacceptable. So, do you share my disappointment in that respect? And, secondly, what course of action do you propose the committee should take if, at the third time of asking, we still don’t get answers to our questions?Finally, I hope the committee can reflect through our work the core principles of youth work, in terms of offering young people empowering, educative, expressive, inclusive and participative experiences. And you referred to the very meaningful engagement with young people that clearly will be—has been, and will continue to be—a central feature of our work. But I’m just wondering whether we can take that further. Could we, for example, delegate the choice of a future inquiry to young people? Could we develop opportunities for young people to shadow committee members in some way? Should there be a young people’s vision of the Children, Young People and Education Committee, maybe as part of the proposed young people’s assembly, so that we can truly maximise the involvement of children and young people in our deliberations as a committee over the months and years to come?

Lynne Neagle AC: Can I thank Llyr for his kind comments to me, and thank him, too, for his questions, which I will do my best to answer? I completely agree in relation to prevention. We know that it’s absolutely key in all sorts of areas, and it’s something that we always need to be trying to do more of. I think that is one of the reasons why our inquiry into the first 1,000 days will be so important, because we know that that first two years of a child’s life is absolutely critical, and I hope that we can add value to the work that the Government is doing on this to try and really make that a time when we can focus on prevention. The other area, of course, is child and adolescent mental health services. We know that there are lots of children and young people who are being referred into specialist CAMHS who don’t perhaps need specialist CAMHS, who should be getting support in the school system, through youth services. And I think that the work that we are doing in scrutinising the Together for Children and Young People will hopefully help drive that work forward in schools, in youth centres, and with counsellors, and make an important contribution to that. I agree with you about the importance of parity of esteem between vocational and education. It’s not an area that, as you know, we’ve spent a lot of time on so far, only in consideration of things like Diamond, where the committee was able to welcome the emphasis that Professor Diamond put on funding students in vocational training as well. And I hope that we will be able to continue that. I would like to see it being a thread in lots of our inquiries, and you’ll know that in our early scrutiny of the additional learning needs Bill, one of the issues that is coming up regularly is to ask why the Bill doesn’t cover things like apprenticeships. And I think we need to keep doing that, really, to mainstream into all our work.In relation to the points you’ve raised about the Minister for Lifelong Learning and the Welsh Language and CWVYS, obviously I shared the committee’s concerns about the way that the dialogue with CWVYS was handled. I was very clear about that at the time, and I was very keen to pursue those concerns with the Minister. Clearly, it would have been better if we’d had straight answers from the very beginning. I think it is very important that Ministers engage as openly as possible with committees. I know that the Minister has received our most recent letter, and I really hope that we will now get a definitive answer and be able to move on, really, to consider what is a huge issue, which is the whole future of youth services in Wales. And then, finally, your points on young people and their involvement, I think, are really important. I know that the culture and media committee did an exercise in public engagement, asking people to choose an inquiry, and I would certainly be very enthusiastic about doing that with young people. I’m also very, very keen, really, to look at any innovative things that we can try, such as shadowing opportunities or maybe even having a shadowing committee. I’d like to see us having young people in here and involving them. Anything that I think encourages young people to get involved is going to be vitally important, especially with the challenges that we face going forward.

Mark Isherwood AC: If I could just ask you two questions relating to your statement: you refer to the committee inquiry into the educational outcomes for Gypsy/Traveller and minority ethnic learners. I wonder if you could tell me, did you take evidence from John Summers High School in Flintshire, which has played a great and leading role in engaging with the local Gypsy/Traveller community and improving educational outcomes for young people? The community and the school have expressed concerns that that has not been factored into decisions over the school closure, which could adversely impact the connection with the community that’s been achieved.Secondly and finally, you referred to the scrutiny that will carry on with the additional learning needs Bill. You referred to children, quite rightly, being involved, and stakeholders and practitioners. You don’t mention parents. Can you confirm that parents will be involved so that you can share their practical experience of concern that this might lead, on the basis of experience to date, to rationing, if not handled properly, where the move away from statements to school action and school action plus, has, in some cases, led to a greater number of exclusions, particularly amongst children on the autistic spectrum and otherwise, and has often frustrated access to services?

Lynne Neagle AC: Can I thank Mark Isherwood for those questions? As far as I’m aware, we didn’t receive any evidence from the John Summers school because our inquiry was specifically around the decision of the Welsh Government to amalgamate the funds that were given to support Gypsy/Traveller learning and minority ethnic learning into one big grant, called the education improvement grant. It’s been a fairly short inquiry and we’re due to report soon. I will check with the committee service whether we may have received something in writing, but I don’t believe that we did. It was a very focused inquiry.Thank you for your points about the ALN Bill. My statement did in fact refer to consultation with parents. We’ve got events with parents in north and south Wales and there is a written consultation as well, which will also be an opportunity for parents. Of course, parents are very actively involved in some of the organisations that are giving evidence. You’ve made the point, I know, previously about the possible dilution of support by moving to a system where everybody has an individual learning plan and that is something that we are examining. In every meeting, really, in this scrutiny so far, it’s come up, and I think I can say that everybody wants this Bill to work. There’s really unprecedented cross-party support for getting something that works for children and young people and their families. And I’m sure that the Government is very, very keen to get something that works. I can certainly give the commitment that we will all be scrutinising that very closely. This is about improving things for children and young people and not by any means rationing or making things in any way worse.

Thank you very much for persevering through that with your voice. I’m sure that the committee will go on and you’ll come back to us with more statements. So, thank you very much for that.

7. 5. Debate by Individual Members under Standing Order 11.21(iv): Contaminated Blood

A PowerPoint presentation was shown to accompany the debate. The presentation can be accessed by following this link:

PowerPoint presentation.

Item 5 on the agenda is a debate by individual Members under Standing Order 11.21 on contaminated blood. And I call on Julie Morgan to move the motion. Julie.

Motion NDM6191 Julie Morgan, Dai Lloyd, Rhun ap Iorwerth, Mark Isherwood, Hefin David, Jenny Rathbone To propose that the National Assembly for Wales:1. Calls on the UK Government to hold a full public inquiry into the contaminated blood tragedy of the 1970s and 1980s.2. Notes that 70 people in Wales have died from HIV and Hepatitis C acquired when they received contaminated blood or blood products and others are still living with these diseases.3. Acknowledges that bereaved relatives are living with the consequences of this tragedy.4. Notes that, in March 2015, the UK Government apologised to people infected by contaminated blood treatment and further notes that the affected families have never received full answers about how this was allowed to happen and are still campaigning for justice.

Motion moved.

Julie Morgan AC: Thank you, Deputy Presiding Officer, for calling me to open this individual Member’s debate, calling for a full public inquiry into the contaminated blood tragedy of the 1970s and 1980s, and thank you to the cross-party Members who have jointly submitted this motion with me: Dai Lloyd, Mark Isherwood, Hefin David, Jenny Rathbone and Rhun ap Iorwerth, who will conclude the debate, and I know that there are other speakers as well.Seventy Welsh people have died in what has been called the biggest national tragedy ever in the NHS—273 people were infected by contaminated blood in Wales. Many of them are still suffering and the pain still continues for them and their families. In the 1970s and 80s, 4,670 people in the UK suffering from haemophilia contracted hepatitis C, and between 1983 and the early 1990s, 1,200 were infected with HIV. The names of 49 of the 70 who died are appearing on the screens in the Chamber now, and will appear again in the concluding speech. We want this to be an opportunity for Assembly Members to hear the stories of some of those people, and I hope that the National Assembly for Wales will send a clear message to the Government in Westminster that we need a public inquiry to look into this contaminated blood scandal.

Huw Irranca-Davies AC: Can I ask whether you’ll give way or not?

Julie Morgan AC: Yes. Briefly.

Huw Irranca-Davies AC: Thank you Julie for giving way. Could I just say the debate today, but also the call for the public inquiry, has the support of my constituents in Llanharry and also in Maesteg, who I’ve dealt with over many, many years? My constituent from Llanharry whose son was infected by hepatitis C aged 12 and whose liver is borderline cirrhotic, who also had her two nephews infected at the same time, one of whom subsequently died and the other had a liver transplant, may draw attention to Lord Winston’s description of this as the worst treatment disaster in the history of the NHS. You have their support, and this call for a public inquiry has their support, as do many others.

Julie Morgan AC: I thank the Member for that contribution. At this point, can I pay tribute to Lynne Kelly and Haemophilia Wales for the work that they’ve done, not only to highlight the issue and the need for a public inquiry, but also for the work they’ve undertaken to try to achieve fair payments for those who have suffered, and for their families? We know that the consultation about the money payments in Wales is only just concluding, and that the health Minister will be making a decision about what those payments are. We know that the families are unhappy about the English scheme, and tend to feel that they’ve been thrown crumbs from the table. The reason that people affected by this scandal, led by Haemophilia Wales, feel that they now need a public inquiry is simple: it is a quest for the truth. They’ve been on a long journey, from individuals and their families first being told that they’d been given contaminated blood and that they could develop HIV or liver disease, to dealing with increasingly poor health, to fighting for compensation payments. In the past, many of them felt that they could trust the Government to do the right thing, that they would get the support they need because their lives had been damaged beyond repair through no fault of their own. That view has now changed. They want a public inquiry in order to get at the truth about what happened when they received contaminated blood. The Archer report was an independent inquiry, but it did not serve the purpose of a full public inquiry. It was not a statutory inquiry under the Inquiries Act 2005, it had no power to compel anyone to give evidence, or to produce documents. The Department of Health actually declined to provide witnesses to give evidence in public. In addition, its remit was not to find out what happened, who was at fault, but to find a way forward. So why do they want a public inquiry? They want a public inquiry to find out why blood continued to be given in the 1970s and 1980s when the dangers of infection were known. The Archer report said that the blood industry was a powerful lobby. Why did blood continue to be imported from the United States, where a large proportion of the blood was from paid donors and came from those who most needed money, those who were most susceptible to infection, and often infection that was not treated? Why did the ministerial papers disappear? In 1975 Lord Owen, who was health Minister at the time, set aside money for the UK to become self-sufficient, so there would no longer be any need to import blood. In 1987, long out of office, when he learnt that self-sufficiency had not been achieved, he sought access to the ministerial papers at the time and found that they had been destroyed under the 10-year rule. Does anyone know what the 10-year rule is? All this needs to be finally cleared up. David Cameron apologised last year for the tragedy, but he did not grant a public inquiry. That’s what we’re asking for now. Before I conclude, I want to refer to some of the people and families affected by this scandal. Barbara Tumelty is my constituent, and she says to me:‘I am writing as a bereaved family member concerning the contaminated blood scandal. I would like you to mention my brothers’ names in the Assembly debate. They are Haydn and Gareth Lewis. They died May and June 2010, and both were infected with HIV and Hepatitis C and possibly CJD too. I would ask you to call for a full public inquiry as was granted to Hillsborough families eventually. Although the UK Government has issued an apology, we, as families, still seek to find answers and accountability for actions that still go without blame all these years later. Gareth was the co-founder of the Birchgrove Group, a support group that was set up to help haemophiliacs, and their families, who were infected with HIV, and was the founder of Haemophilia Wales.’Leigh Sugar is Mick Antoniw’s constituent, and this is what his widow, Barbara Sugar, asked me to say,‘My husband, Leigh Sugar, was a mild haemophiliac who was infected with hepatitis C at 14 years of age, following a fall from a horse. His parents were not warned of the risk of the new factor VIII. Leigh’s parents were not told that the new treatment of factor VIII concentrate contained blood donations from up to 20,000 donors. Only one donor with hepatitis C or HIV would be enough to contaminate the whole batch. Leigh’s first treatment with factor VIII infected him with hepatitis C, a lethal virus that destroyed his liver and killed him at the age of 44. Leigh worked up until the year before he died. He trained as a mechanic and bought his own garage and built up a successful business to support his two young daughters. The stigma attached to hepatitis C meant that he didn’t tell anyone, not even his business partner, and when he became ill, he continued to keep this secret. Leigh was diagnosed with liver cancer and spent the last years of his life in intense pain and suffering. He died in June 2010. His brother was also infected with hepatitis C at the same time and underwent a liver transplant last year. Leigh’s parents will never recover and our family’s been torn apart by contaminated blood. We hope that by getting to the truth we will get closure and understand why this was allowed to happen.’

Mark Isherwood AC: Well, as we’ve heard, in the 1970s and 1980s, blood products supplied to patients by the NHS were contaminated with HIV or hepatitis C. Around 4,670 patients with haemophilia blood-clotting disorder were infected, over 2,000 have since died in the UK with, as we heard, 70 in Wales, from the effects of these viruses. Successive UK Governments have since refused to hold a public inquiry into these events. The 2009 independent inquiry under Lord Archer made strong recommendations to Government, some of which have been implemented. In 2008, the Scottish Government set up a public inquiry under Lord Penrose. Following publication of the final report of the Penrose inquiry in March 2015, David Cameron did apologise for the contamination disaster and promised to improve financial support. Nicola Sturgeon also apologised and, following a full consultation with those affected there, announced a new Scottish scheme focusing on those most in need. The Scottish scheme offers improved payments to those with more advanced HIV and hepatitis C, addresses those in most urgent financial need and, for the first time, widows there are entitled to regular payments and will no longer be forced to apply for means-tested discretionary support, offering some security via annual payments of about £20,000. In England, widows will only have a one-off payment of £10,000.Currently, the UK Government provides partial support to some individuals and families through various charitable trusts funded by the Department of Health. Following a 2016 consultation, the UK Government announced a support package of £125 million to improve support for victims in England, with devolved administrations taking responsibility for future schemes and payments in their own nations. In October 2016, the Cabinet Secretary for Health, Well-being and Sport here announced, as an interim measure, payments for the remainder of the 2016-17 financial year at the same levels as England, adding, ‘However those affected may have ideas about how this money can best be used to assist them in everyday living and planning for the future. To inform our future arrangements, I am now seeking further views on a new scheme from April 2017’.The Irish Republic scheme is widely heralded by victims as the best model, offering a choice of a one-off payment or ongoing payments, life assurance and mortgage protection, and a health amendment card that ensures access to treatment and support. Referring to ‘this absolutely tragic situation for all involved’—their words—Cruse Bereavement Care told me that ‘People have been living with this for 30-40 years. Given the stigma around blood disorders, family members have to deal with the reactions that come with it. In some cases this manifests itself in a sense of needing to feel justified and to have pain recognised—privately as well as publicly. Broadly, when Cruse is able to offer bereavement support, we find that the bereaved experience is that there can be more unanswered questions for longer, which can have a profound effect upon people who have been bereaved. Unfortunately, we also see this in suicides or cases when suicide or foul play is suspected, but the family/friends are never entirely sure. The unknown element can be caustic and can result in people entering into cyclical thinking about what might have or actually happened. Our past is important to us, and this gives us some of our identity. With significant unknowns present such as this, it can leave people feeling unstuck.’Let me briefly quote—to add to the examples given—Monica Summers, whose husband, Paul, and contaminated blood bank victim, died on 16 December 2008, aged 44. Their daughter was five years old. Monica says,‘Every day for 18 months she asked “when is daddy coming home?” She turned 13 years in October and we both struggle. My husband didn’t have a choice, it was made for him and he lost his life because of decisions taken by others. Yet over 30 years later we are still trying to get some agreement. Please let the next decisions be made by voices of people who are currently suffering with HIV and Hepatitis C, by the widows and families left behind trying to heal and build a new normal life.’Contaminated blood has had, and continues to have, a devastating impact on the lives of thousands of people with haemophilia and their families. Those infected live with the health effects of viruses, with more deaths each year. As Haemophilia Wales states,‘A Public Inquiry is the only way forward to get to the truth about the State’s mishandling of these events.’

Hefin David AC: Dirprwy Lywydd, this is less a debate today and more a call for action. We are calling on the Government to act on behalf of those who seek justice for themselves and for their families.In her opening contribution, Julie Morgan mentioned a constituent of our colleague, Mick Antoniw—Mr Leigh Sugar—who passed away from hepatitis C. Mr Sugar’s aunt is a constituent of mine—Mrs Dorothy Woodward. She has expressed to me her hope that the Welsh Government will do the right thing today and recognise the impact this tragedy has had on the lives of all the families affected. It’s good to see the Cabinet Secretary for Health, Well-being and Sport there to listen to that plea.I’d also like to speak about the stories of two more of my constituents, who contacted me ahead of the debate today. Mr Kirk Ellis is 35 years old. He has haemophilia and he was infected with hepatitis C at just two years of age. Kirk has continued to work, even when undergoing various chemotherapy-type treatments to eradicate hepatitis C. He’s had such severe side effects that it has forced him to stop treatment purely because it made him unable to work, and he couldn’t afford not to work. Unfortunately, Kirk has been recently informed that he has cirrhosis of the liver, caused by hepatitis C. His disease has not been adequately monitored as there have been delays with the appointment of a consultant hepatologist at the University Hospital of Wales, Cardiff. Kirk had been overlooked, and when he was eventually seen by the newly appointed hepatologist, it was confirmed that he had had cirrhosis as early as May 2015. Unaware of the deterioration in his liver, Kirk and his partner decided to start a family, and they now have a 15-week-old baby. Since his diagnosis, Kirk has continued to work but has lost his disability living allowance and his housing benefit. He feels that he is being penalised for trying to stay at work despite being ill with the side-effects of treatment.Another of my constituents got in touch to tell me the tragic story of how his family had been affected. His younger twin brothers were infected with HIV and hepatitis C by contaminated blood transfusions supplied by the NHS to treat haemophilia. After many years of terrible illness, they succumbed to the effects of HIV. My constituent’s brothers suffered discrimination, as well as verbal and physical abuse to—and he put this in quotes—’having AIDS’. Their mother never recovered from the death of her youngest sons and lived in her final years with depression. It’s been very difficult for him to contact me and speak about this, but he expressed to me his hope that the personal stories of all the affected families will help to finally achieve some closure on this matter, which is why the names have been on the screen today of those who’ve passed, and why I’m telling these stories. These are just two examples from people in Caerphilly. Can any of us imagine how this must affect people who are suffering through absolutely no fault of their own? It’s a grave injustice, and it’s absolutely essential that the UK Government holds a full public inquiry into why this has happened. It’s not a party-political issue. The inquiry needs to be UK wide, as these events happened prior to devolution and occurred in all corners of the UK. I know that the Cabinet Secretary has recently finished consulting on the sustainable compensation package for people in Wales who’ve been affected by this tragedy. I would urge him to listen to their views as much as possible, and their stories, when putting his plans in place. Kirk Ellis feels strongly that Wales needs to adopt a compensation scheme similar to that in Scotland so that his family can support themselves should anything happen to him. Many of those in Wales living with the effects of this tragedy do not feel that the current compensation scheme, which mirrors that in England, goes far enough. I hope that, today, we as Assembly Members have given a voice to constituents who’ve been affected by this terrible tragedy.

Dai Lloyd AC: It’s a pleasure to participate in this important debate this afternoon. There is unanimity on this issue. May I start by acknowledging the work of the cross-party group here in the Assembly, chaired by Julie Morgan? I thank her for her opening remarks. Of course, I also thank Haemophilia Wales and Lynne Kelly for all the support that they’ve provided and their very strong evidence, their very passionate evidence, provided in the meetings that we have attended over these past few months.Efallai fy mod wedi sôn o’r blaen wrth fynd heibio fy mod wedi bod yn feddyg teulu yn Abertawe dros y 32 mlynedd diwethaf. ‘Cynhyrchion gwaed a fewnforiwyd o’r Unol Daleithiau sydd wedi achosi’r problemau. Tuedda cynhyrchion gwaed yr Unol Daleithiau ddod o garchardai. At hyn, caiff pobl eu talu am gyfrannu gwaed yn yr Unol Daleithiau, ac felly mae grwpiau perygl uchel, megis rhai sydd yn gaeth i gyffuriau, yn tueddu i gymryd rhan. Ni fu unrhyw un o Lywodraethau’r DU yn hunan-gynhaliol o ran cynhyrchion gwaed. Addewidwyd y nod hwnnw gyntaf yn 1945, ond nid ydym wedi ei gyflawni o hyd. Mae hepatitis C yn gyflwr arwyddocáol ac ni ddylid ei ddiystyru fel mân haint. Gall ymosod ar yr iau, a gallai fygwth bywyd. Gall hyd at 80 y cant o’r sawl a heintiwyd ddatblygu afiechyd iau cronig, gall hyd at 25 y cant, yn ôl rhai astudiaethau, ddatblygu sirosis yr iau, ac mae perygl y gall hyd at 5 y cant ddatblygu canser yr iau.’ Mae angen diweddaru rhywfaint o’r wybodaeth honno, gan mai’r tro cyntaf i’r geiriau hynny gael eu clywed oedd gan fy nghyd-Aelodau Cynulliad ar y pryd pan gynheliais ddadl fer yn y Cynulliad ar 8 Mawrth 2001—8 Mawrth 2001. Yr un mater—ymchwiliad cyhoeddus, iawndal. Mae ein pobl yn dal i ddioddef. Roeddwn yn cymryd tystiolaeth bryd hynny gan bobl sydd wedi marw bellach, yn anffodus—Haydn Lewis, Gareth Lewis—roeddent yn rhan o’r ymgyrch, a siaradais yn hir â hwy. Dyna oedd ffrwyth y ddadl rwyf newydd ei dyfynnu o’r Cofnod 16 mlynedd yn ôl. Nid oes dim wedi newid i’r bobl ar lawr gwlad yma yng Nghymru ac mewn rhannau eraill o’r Deyrnas Unedig. Jane Hutt oedd y Gweinidog Iechyd ar y pryd, ac fe atebodd fedrus. Roeddem mewn Siambr wahanol. Mae’r ddadl yr un fath, sy’n ddigon i’ch gwylltio—yr un fath. Rydym wedi clywed hanes ymchwiliad Archer. Rydym wedi clywed am yr holl anghyfiawnder sy’n mudferwi. Oherwydd mae hwn yn anghyfiawnder sy’n mudferwi. Mae’n rhaid i ni gael yr ymchwiliad cyhoeddus llawn hwnnw. Mae’n gywilyddus fod Llywodraeth y Deyrnas Unedig wedi osgoi’r mater, wedi gwrthod mynediad at bapurau, gan obeithio y bydd y mater yn diflannu a bod pobl yn marw. Nid dyna’r ffordd i redeg llywodraeth yn y Deyrnas Unedig. Mae gennym i gyd hanesion am deuluoedd sy’n dioddef: gweddwon ifanc gyda phlant ifanc mewn tlodi am fod y tad wedi marw yn anffodus o ifanc oherwydd cynhyrchion gwaed halogedig fel person hemoffilig; pobl sy’n byw gyda hepatitis C, nad ydynt yn ffit i weithio—cosb gydol oes o flinder ac anhwylder aruthrol ac eithafol—ynghyd â’r risgiau y soniais amdanynt bron i 16 mlynedd yn ôl yma. Ni allwch gael sicrwydd yswiriant bywyd na diogelu morgais, ac eto ni allwch ychwaith gael iawndal digonol yn sgil rhywbeth nad yw’n fai arnoch chi. Rydym yn llusgo ar ôl yr Alban, rydym yn sicr yn llusgo ar ôl Gweriniaeth Iwerddon—buom yn siarad am yr angen am iawndal yma i’n pobl yng Nghymru ers blynyddoedd. Rydym yn disgwyl i Ysgrifennydd y Cabinet newid y sefyllfa honno, gan fod gennym bobl sy’n byw mewn tlodi heb fod unrhyw fai arnynt hwy.Felly, mae angen i ni roi iawndal digonol i deuluoedd. Rwy’n dweud wrth Lywodraeth y Deyrnas Unedig: mae’n hen bryd i hyn ddigwydd, mae’n hen bryd sicrhau cyfiawnder—cynhaliwch ymchwiliad cyhoeddus llawn i drasiedi cynhyrchion gwaed halogedig. Nid yw ‘sgandal’ yn air rhy gryf. Mae anferthedd y dioddefaint wedi mynd heb ei gydnabod yn rhy hir—mae’n enfawr.Rwy’n falch o gymryd rhan yn y ddadl hon heddiw, fel yr oeddwn yn falch 16 mlynedd yn ôl i gymryd rhan mewn dadl debyg. Cynhaliwch yr ymchwiliad cyhoeddus hwnnw yn awr. Diolch yn fawr.

David Rees AC: As has already been said this afternoon, there are many people in Wales who have been infected with either HIV or hepatitis C as a consequence of contaminated blood products, which came to them as treatment, and, as Hefin David pointed out, on many occasions as young children. Sadly, many of those infected have passed away. The pain of the families that have lost loved ones has not gone away, but neither has the stigma or the suffering of those still living with illness as they continue to face the challenges of the lives ahead of them. As has been pointed out, during the 1970s and 1980s, in Lord Archer of Sandwell’s inquiry, which was an independent inquiry—. As he stated, the Department of Health favoured commercial interests and costs to the detriment of public safety, and the UK was slow to react to the dangers of HIV and hepatitis C. It was also slow to become self-sufficient in blood and blood products, relying very much on buying in those products, particularly from America. We all understand that, in America, of course, blood was collected by way of monetary payment for the giving of blood on many occasions—it was not as it is today.Dirprwy Lywydd, as has already been pointed out, I want to highlight the impact on one of my constituents, David Farrugia. His father, Barry, and two uncles, all received contaminated factor VIII used to treat haemophilia. The consequences of this were that his father and one of the uncles became HIV positive and subsequently went on to contract AIDS, and the other uncle contracted hepatitis C. At different times, unfortunately, all three sadly passed away—from 1986 up to 2012.However, the pain and the stigma the family experienced and continue to experience—they continue to suffer today, even though their loved ones have passed away. Days after the death of their father, Mr Farrugia’s sons were separated, and two of them—twins—were actually sent to care homes 100 miles apart. But, before they could be admitted to the care homes, the care homes insisted on a blood test to ensure that they weren’t contaminated. Now, that is something that is unacceptable. What effect does that have on anyone going there, let alone a child who’s just lost his parent? It is unacceptable behaviour from the public sector.There were four brothers in total, and they were not reunited for over 20 years. That is the emotional and psychological impact of the death of a loved one from contaminated blood products, and the actions that occurred to them after that totally need to be addressed. Dirprwy Lywydd, I’ve got to declare a personal interest, as I actually have a nephew who suffers from haemophilia and was infected by contaminated blood in the USA. He is an American citizen, so he’s not going to be affected or impacted upon by anything we do here today. But the challenges he faces, and he has faced, continue, and they’re the same challenges that face people in Wales today.In the US, there was federal action to support those infected by contaminated blood. Similar actions should be taken across the whole of the UK. I am concerned that the UK Government is not even considering an inquiry into the use of contaminated blood and blood products. Actually, the then UK public health Minister, Jane Ellison, wrote to my colleague, MP for Aberafan, Stephen Kinnock, in January 2016, stating:‘Another inquiry would not be in the best interests of sufferers and their families as it would be costly and further delay action to address their concerns and significantly delay plans to reform existing payment support schemes.’That is simply not good enough. Those families and those sufferers want answers as to how they and their loved ones were infected. A consideration that it wouldn’t impact upon them, I’m sorry, is unacceptable to any politician who’s really concerned about the lives of their individuals and the people in Wales. The UK Government has a moral responsibility to provide them with answers, and it must meet its obligation to provide support, including compensation to those infected and their families. There are key issues the Department of Health need to address around liability and parity of support schemes across the home nations. And it’s already been heard—I think Mark Isherwood has quite clearly identified the schemes across the UK—and I think there is a requirement for more certainty for people here in Wales. Perhaps the minimum certainty should be in line with the recommended payments identified by the Archer inquiry, which has already been implemented in southern Ireland. And Scotland’s system introduced to talk about supporting widows—perhaps we in Wales go one further, in supporting bereaved families, because there are children who are dependents of individuals who have been lost. We have seen families break up as a consequence of contaminated blood and the infections created because of them. What happens to the children of those families? We perhaps can go further than just individual support, and widows’ support, and help the families as well. The whole system seems to be designed to make you feel like a beggar. It’s not acceptable—no-one should have to beg to receive support that we as Governments should be providing for them without complication, and I urge the Welsh Government to take this matter up as a matter of importance and urgency with the UK Government.

Caroline Jones AC: I’d like to thank Julie, Dai, Rhun, Mark, Hefin and Jenny for tabling this individual Member’s debate and for giving us all the opportunity to discuss this very important topic. The contaminated blood scandal is one of the darkest periods in the history of our NHS. The fact that people who sought help from the health service were exposed to deadly viruses is shocking enough, but the fact that they have been denied a proper explanation as to how this was allowed to happen is inexcusable. The previous UK Government did apologise to patients infected by contaminated blood and their families, but they were still denied a full, independent public inquiry.Successive Governments have monumentally failed to address the concerns of the victims of the contaminated blood scandal. In comparison, following pressure from the Scottish Parliament’s health committee, the newly elected SNP Government in 2008 ordered a full public inquiry into the infection of people with hepatitis C and HIV contracted from NHS treatment. The inquiry began in 2009 and published its final report in March 2015. The report spans five volumes and runs to over 1,800 pages, having considered the treatment of bleeding disorders and blood transfusions in Scotland between 1974 and 1991.The people of Wales deserve no less. We need a full, independent inquiry covering the use of blood and blood products in the Welsh NHS. Seventy people have died in Wales as a result of the contaminated blood scandal and numerous others are living with diseases they acquired as a result of the treatment they received. However, we don’t know how many others have received treatment, contracted an infection, but remain undiagnosed. The Scottish inquiry recommended that everyone who received a blood transfusion before September 1991 be tested for hepatitis C. That’s the purpose of such inquiries: to establish the facts, to make recommendations and to ensure that lessons are learnt so that we don’t make the same mistakes again.We need to establish the facts of what went on in our health service during the 1970s, 1980s and 1990s. These families deserve an explanation. How was a large American pharmaceutical company allowed to collect blood from prisoners in America and from the third world without any testing of the donors? How were the products produced from this blood licensed? Were products produced by this company still used in Welsh hospitals after they were withdrawn from the US? Have we learned anything from this dark period in the NHS’s history and are we sure that something like this could never, ever happen again? Only a full, independent public inquiry can address these questions. Only a full, independent public inquiry can provide answers to the victims of this scandal. And only a full, independent public inquiry can provide closure for those who have sadly passed away, and their families, as a result of receiving this contaminated blood. I urge the Welsh Government and the UK Government to work together to do the right thing and order such an inquiry while many of the victims are still with us. Thank you very much. Diolch yn fawr.

Vikki Howells AC: I would like to start today by thanking the Members in whose name this motion appears on today’s agenda. This is a very important subject, where we have the opportunity to call for redress for those lives touched by the contaminated blood tragedy. For my contribution today, I would like to focus on the stories of two of my constituents who were affected in this way. The first story is from a constituent who, understandably, wishes to remain nameless. He says: ‘I was 17 years old and ready to start my life when I was told by my Haemophilia Doctor that I had HIV, I was told not to tell anyone, not even my mother. They told me I would live about 18 months. I had seen AIDS victims on the TV and so I thought I would die in the same way. This was a death sentence, I signed myself out of hospital and started taking sleeping tablets, as when I was asleep I wasn’t thinking about the reality of what was happening. During the next few years I took more and more sleeping pills, morphine and pethidine, in fact anything to numb the effect and stop the mental torture. I would take 5 or 6 at a time, up to 90 a week. I had a nervous breakdown and was admitted to Whitchurch Psychiatric hospital and tried to kick the habit. For years I spent spells in and out of hospital where I witnessed other Haemophiliacs I had known dying from AIDS. One such victim Mathew was a young man who was a couple of years younger than me and looked up to me, he was going to die imminently and I was asked to stay in hospital a few days longer by the Haemophilia doctors until he died. I had become an addict to sleeping tablets and pain killers and my doctor stopped them all one day, I was climbing the walls as I was given no help, I broke into the local pharmacy to try and get tablets to numb the pain. I attempted suicide many times, my mother witnessed all of this.‘In 1994 I was told that I was also infected with Hepatitis C, I underwent many courses of treatment with horrendous side effects and eventually was clear of the virus 3 years ago. I was told that I had cirrhosis due to Hepatitis C but I have been refused stage 2 ongoing payments from the Skipton Fund. All my life I haven’t been able to get life assurance or mortgage protection due to HIV and Hepatitis C. I live day to day, I met my wife over 20 years ago, we would like to have some recognition of what has happened to me and how my life has been ruined. We would like financial support to offer us some degree of security. Instead we have to make applications for means tested support which is usually turned down.’The second story is from my constituent Jeff Meaden, who I’ve been in correspondence with for some months. Jeff writes movingly about his much-loved wife Pat. Patricia Meaden died of liver cancer and liver failure in January 2014. Pat had contracted hepatitis C through treatment she had received for a blood clotting disorder. She was ill for most of 2013 but wasn’t referred for a liver transplant and developed liver cancer. Her widower Jeff says:‘We lived in the same street as children and played together as children. We first went out together when we were 14, her death was so unnecessary, I am broken hearted. My wife would have been alive it if hadn’t been for Hepatitis C, it has ruined our lives and nobody is taking any responsibility for it.’The stories of my unnamed constituent and Pat Meaden highlight some of the ways in which lives have been changed as a result of the contaminated blood scandal: the psychological impact; addiction to medication; suicide attempts; refusal of life assurance or mortgage protection; financial insecurity; and death. But their stories also highlight the way the contaminated blood scandal has affected those around them and I am glad that this aspect has also been touched upon in the motion today. I have no hesitation in supporting this motion today and its call for justice. Thank you.

John Griffiths AC: I welcome this opportunity to contribute to the case for recognition of this contaminated blood scandal and tragedy and its ongoing consequences to support the campaign for justice by affected families and Haemophilia Wales and the need for full answers as to how it was allowed to happen. Dirprwy Lywydd, my constituent Lynn Ashcroft’s husband, Bill Dumbelton, was a haemophiliac and one of the first to treat himself at home with cryoprecipitate. As a result of contamination, he contracted HIV and hepatitis C and died aged 49, leaving her a widow at 35. Bill had no life insurance: he could not get any as a haemophiliac. Lynn was left to cope with the mortgage and all the other financial pressures. She found available support inadequate and dispiriting and believes the UK Government should ensure financial security for survivors. Lynn says the UK Government has no conscience and has lost the plot. She does not want the one-off £10,000 payment on offer, which she considers insulting. My constituents Janet and Colin Smith’s lives were torn apart by the death of their son, Colin. Little Colin was a haemophiliac and given a batch of contaminated blood product in the middle of the AIDS crisis. At age 7, after years of suffering, he died in his mother’s arms weighing 13 pounds. Colin and Janet think Little Colin knew he was going to die. He told his brothers they could have his toys. He obviously knew they would get to use them for longer than he would and he had turned to his brother Daniel and said, ‘You will miss me, you know.’ And Daniel does miss him, as do his other brothers, Patrick and Darren. Dirprwy Lywydd, the family have been denied answers as to why the provision of contaminated product was allowed to happen. It was, in fact, a freedom of information request that revealed the blood was from a prison in Arkansas and it wasn’t until three years after his death that Colin’s parents discovered he had hepatitis C. That had been kept secret from them. They continue to be ignored and feel strongly that they have to continue to fight for justice for Little Colin and everybody else affected by this tragedy. Dirprwy Lywydd, families and Haemophilia Wales have now been waiting some 30 to 40 years for the truth and they are crystal clear: they need a public inquiry to get that truth.

I now call on the Cabinet Secretary for Health, Well-being and Sport, Vaughan Gething.

Vaughan Gething AC: Thank you, Deputy Presiding Officer. I want to begin by thanking Julie Morgan as chair, cross-party group members and all of those who’ve contributed to today’s debate. There’s been powerful testimony from all sides, not just about the injustice and unfairness, but in particular about the impact on individuals and families, whether that’s the impact on work, the ability to get insurance, but also the stigma that goes with contaminated blood and the shame that people feel. Whether they’re right to feel shame is an entirely different thing—I don’t think they should be ashamed at all—but it’s how people really do feel and how it’s impacted on their lives. And then, of course, there are the other medical problems, especially those mental health problems. So, I want to say at the outset that I strongly support the call for the Government to hold a UK-wide public inquiry into the circumstances that led to people contracting hepatitis C, HIV or both from NHS-supplied contaminated blood products. I know this has been described as some of the worst treatment in the history of the NHS. People were infected by NHS treatment and it should never have been allowed to happen, but it did and I am truly sorry about the harm that has been caused and the impact this has had and continues to have on those affected. The impact of those infections on people’s health and well-being has been hugely significant and highlighted again in the Chamber today, with wide-reaching consequences for lives, dreams and aspirations. And, of course, some have lost their lives permanently, as Julie Morgan outlined in opening the debate. I have had the opportunity to hear first-hand, both in the cross-party group but also in private ministerial meetings, about the views of affected individuals and their families, including representatives of Haemophilia Wales and Assembly Members. I’ve been further informed by feedback I’ve had from Welsh Government officials following the recent workshops that they held with those affected to help inform our future direction in Wales on the financial support that we will be able to provide. What is clear to me and everyone in this Chamber who has listened is the incredible strength of feeling about what happened, and a plain and simple demand to know all the circumstances and facts about what happened. And I support them in that demand, because I know that they seek closure in order to be able to move on. And the calls for a public inquiry over many years across more than one Government by those campaigning have been ignored. To many, we understand that this has added insult to injury. I certainly believe that a full and independent investigation into the circumstances is right and appropriate. In October last year, I wrote to Lord Prior following the Prime Minister’s commitment to consider a review into the issue of contaminated blood, and I asked how the devolved administrations would be engaged. I then wrote to Jeremy Hunt on 20 December adding my voice to the call for a UK-wide public inquiry. And it’s clear that that inquiry can only take place if the UK Government acts. It’s not just because these events took place before devolution. It’s not just because we can’t always know where people were infected. But, of course, only the UK Government has access to the information and the powers for the scope and depth of an inquiry that is required for a meaningful inquiry to help people get to the truth. It is also true, though, that the scandal was not unique to the UK. What is different, though, is that in some other countries like Ireland and Canada, their governments have instigated those inquiries. I do accept that no inquiry can repair the damage that has been done, but it can ensure that we fully understand in a transparent way how the events of this catastrophe were able to happen. It is important, as well as ensuring those who have been so directly affected by the tragedy know, that we also ensure that we take any learning to help prevent any such thing happening in the future. Caroline Jones asked directly: have we learned anything? The truth is we have, actually, because if you look at blood products here in Wales, the safety has significantly improved in terms of traceability and testing. I’ve seen some of those systems in place, and the safeguards on visits that I’ve made to the Welsh Blood Service. But that does not get away from the fundamental injustice for those people who have been infected. As people are aware—and, of course, as was mentioned in the debate—work is under way to reform the system of financial support provided by the Welsh Government. We would have preferred to have done this on a consistent UK-wide basis, but this is where we are. The five infection-specific schemes established since 1988 have evolved in an ad hoc manner, and over time the system has become complex. Some improvements have been made pre and post devolution, such as the introduction in 2009 of annual payments for those with HIV and annual payments for those most severely affected by hepatitis C from 2011. However, there is widespread dissatisfaction that continues about the way and the extent to which people affected are supported. In reforming support for those affected who will fall within the responsibility of the Wales scheme, I have three priorities. Any move to a new system has to be equitable and operate transparently. Improvements need to be affordable and sustainable within the health budget, and decisions will need to take account of the views expressed by those affected. So, in October last year I wrote to individuals inviting them to complete a survey to let me have their views on how best to provide support and how it could be tailored better to meet their needs. My officials also held two workshops, one in north Wales and one in south Wales. This overall process has proved invaluable in gaining first-hand the impact of the tragedy on people’s lives and those of their families in many cases. The survey closed on 20 January and I will consider carefully the information and the views that are expressed to me in making a decision of a path forward. Of course, there has been some more money allocated within this year’s final budget. But it will be a difficult task on the way forward and I know perfectly well I will probably not be able to satisfy all of the demands—and understandable demands—that families will want to make upon me and this Government. But I will be completely transparent about any decision I make, how I’ve made it and what I’m able to do to help support families here in Wales. So, I’ll be considering those issues carefully when making a decision on the way forward for Wales.But I want to finish—because the essential call in today’s debate has been about truth and a way forward—and I absolutely believe it is right and proper that people have answers to their questions about how and why people were infected as well as receiving appropriate support in helping to live with the impact that this tragedy has had and will continue to have.

Thank you. I call on Rhun ap Iorwerth to reply to the debate.

Rhun ap Iorwerth AC: Thank you very much, Deputy Presiding Officer. I’d like to thank everyone who has contributed to this debate this afternoon. I’ll thank also some who haven’t had the opportunity in this afternoon’s debate to express their opinion on record. I’ll name Jenny Rathbone, of course, who’s one who’s signed this motion and who is here in the Chamber supporting this 100 per cent, this motion before us. Can I also thank the Cabinet Secretary for his positive response to the specific call that’s being made by us today? But my thanks goes mainly to the individuals and the families who have lived with this injustice for so long, and the families of those who have lost their lives, and for their dignity and resilience in pressing on us to ensure that they, hopefully, will be able to have justice.Mae’r holl Aelodau heddiw wedi dweud wrthym am brofiadau go iawn etholwyr, ffrindiau, aelodau o’r teulu, hyd yn oed—maent wedi adrodd am brofiadau dirdynnol sy’n dangos yn glir i ni pam rydym yn mynnu’r camau hyn. Cyflwynodd Julie Morgan yr achos dros ymchwiliad yn huawdl. Disgrifiodd Mark Isherwood raddfa’r drasiedi, y sgandal hon, ledled y DU, ac annigonolrwydd y cynllun iawndal. Cawsom ein hatgoffa gan Dai Rees am y stigma sy’n cydredeg ochr yn ochr â salwch. Fe’n hatgoffwyd gan Dai Lloyd fod 16 mlynedd ers i’r Cynulliad drafod yr union fater hwn ac rydym yn dal i aros am gamau gweithredu. A chrynhodd Hefin David ein bwriad yn eithaf syml heddiw fel galwad i weithredu. Mae’r alwad honno’n alwad syml iawn. What we’re demanding this afternoon is very simple indeed. As we’ve heard, 283 people in Wales were infected with hepatitis C or HIV because of contaminated blood in the 1970s and 1980s. Seventy of those have now passed away. Their names are once again on the screens around this Chamber, and behind every name, there is an individual who had to live a life suffering both illness and stigma, through no fault of their own. And behind every name, there is also a family who have had to grieve, through no fault of their own. In the cross-party group on contaminated blood, we’ve heard some powerful descriptions of the experiences of victims and their families, not only the physical impacts of the infection, but also the psychological impacts on them, their families and friends, about the prejudice of people when they told them that they had HIV or hepatitis C, and the guilt felt by many of them who had infected husbands, wives or even babies, unbeknown to them. Because of that, factors such as these, many have decided to suffer in silence. But, to intensify that suffering, Government after Government has also chosen to remain silent and refused to get to the heart of exactly what went wrong and why. Victims and their families deserve to know and they deserve justice.One of the outcomes of this absence of answers, the absence of a perception of what went wrong, is the striking problem, as we’ve heard from many Members, in terms of the compensation packages provided. These demands for an inquiry today don’t replace calls for improved compensation packages for victims. I’m sure the Cabinet Secretary hears my comments on that. Certainly—

Will you take an intervention?

Rhun ap Iorwerth AC: [Continues.]—a full public inquiry shouldn’t be any reason for the Government to delay, any further, coming to a just settlement for those people who have suffered. I will of course take the intervention.

Jenny Rathbone AC: Would you agree with me that what is needed is a full and effective public inquiry, similar to the one that Charles Hendry conducted into the tidal lagoon, not one that takes six years and comes up with one limp recommendation, as happened in Scotland? We need a full public inquiry, so that we know that the NHS is a learning organisation and has learnt from the dreadful mistakes that were made.

Rhun ap Iorwerth AC: I’m grateful to the Member for making that intervention, and she’s absolutely right, of course, that what we want is a full, a complete, inquiry. We’ve waited long enough to get the answers to the questions that we ask. I’m grateful that that point has been made. Inquiries that we have seen in Scotland have been useful in terms of the compensation structure, but it’s not enough in itself.Yn dilyn ymchwiliad Penrose yn yr Alban yn 2005, mi gyflwynodd Llywodraeth yr SNP system newydd well a thecach o gefnogaeth ariannol, am eu bod nhw’n credu bod gan Lywodraeth yr Alban gyfrifoldeb moesol i wneud hynny. Gadewch i ni yma hefyd gefnogi galwadau am ymchwiliad, ond un llawnach, fel cam tuag at roi’r gefnogaeth haeddiannol i ddioddefwyr yng Nghymru hefyd, yn ogystal â’u teuluoedd. Gadewch imi ddyfynnu un o’m hetholwyr i, sydd â’i wraig, Jennifer, yn dioddef o hepatitis C. Mi gafodd ei heintio yn y 1970au. Dyma a ddywedodd o:‘In the 14 years since she has become ill, she’s been unable to do most of the things she did before. In the early days, she was so debilitated that she could not cook; could walk only a short distance; could not drive; found it difficult to understand basic things; she needed help washing and dressing. She has improved slowly, but 12 years later, she still suffers from chronic fatigue, usually spending most afternoons asleep. She cannot cope with day-to-day housework and cooking, but she tries to do some, often making mistakes.’ Crucially, he says:‘In her words, she never has a good day; just bad or very bad’.I’ve met Jennifer and her husband on a number of occasions. I’ve been struck by their dignity; dignity in the face of what they have had to endure in terms of their health and in the face of an unjust compensation structure, and of too many unanswered questions. Seventy of the 283 contaminated in Wales are no longer with us. You’ve seen their names in the Chamber today. We owe it to them and we owe it to all those still living with the consequences of the contaminated blood scandal to seek answers, once and for all. For justice, support today’s motion.

Thank you. The proposal is to agree the motion. Does any Member object? No. Therefore, the motion is agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.

8. 6. Welsh Conservatives Debate: Cities and Urban Areas

The following amendment has been selected: amendment 1 in the name of Jane Hutt.

We now move on to item 6, which is the Welsh Conservatives debate on cities and urban areas. I call on David Melding to move the motion. David.

Motion NDM6215 Paul DaviesTo propose that the National Assembly for Wales:1. Notes the international trend to evaluate cities on liveability, green and sustainability criteria.2. Believes that cities and urban areas are a key driver for economic resilience and prosperity.3. Commends the value of the following objectives and strategies to promote urban renewal and regeneration:a) access to clean, open space;b) availability of affordable housing;c) effective traffic management and the provision of high quality public transport;d) the development of active transport routes, including the re-designation on some existing routes for cycling and walking;e) high standards of air quality;f) investment in the design quality of public and landmark buildings;g) the involvement of citizens in plans to improve amenities, both on a city-wide and neighbourhood basis; andh) the centrality of the city-region concept to the regeneration of hinterlands, such as the South Wales Valleys.

Motion moved.

David Melding AC: Thank you, Deputy Presiding Officer. Can I say that we brought this motion in a constructive spirit? We want to examine the place of our cities and urban areas in our national life, particularly as a driver for growth and something that should be at the very heart of our ambition for a future prosperous, more sustainable Wales. Can I say that we accept the Government’s amendment, which adds to our motion, and we’re happy to accept that?

The Llywydd took the Chair.

David Melding AC: Liveability and citizen engagement are key to the success of modern cities and urban areas in general. All over the world, cities are enjoying a renaissance, people are moving back to cities, their place in national life has never been more emphasised. One notable trend is a growing preference for smaller and medium-sized cities. We hear mostly about the mega cities and their challenges and the place they have in the world economy, but actually, the more innovative cities, the cities that are growing and are doing most to transform their economy and the economies of their hinterlands, are the smaller and the medium-sized cities. Here, Cardiff, Swansea, Newport, and I would also include Wrexham, have great potential. They’ve already done much—and I don’t want anything in today’s debate to take anything away from that—but I think that we need to recognise what great assets they are, and do even more work with them. Another key factor is the issue of sustainability. In the last generation, I think we’ve seen this concept being deeply embedded in our national consciousness, and the need for sustainable, good urban design and vision is now, I think, accepted by all. To have that, there are some key qualities that we require: access to clean, open spaces, for instance, and I don’t just mean Bute park, though that is a magnificent example, but also those neighbourhood parks, particularly, perhaps, in the poorer parts of cities and urban areas, where there is the chance for recreation, particularly for younger people and children. This, I think, is often overlooked, whereas quite small interventions can open up the spaces that are there, can enhance the ones that have existed for many years, and we need to place a real priority on that. Air quality has been discussed quite frequently in the last months here in the Assembly, and I’ll just touch upon that, but it’s always a challenge. In an urban area, you’re going to have more potential pollution and the result of that, if it’s not properly controlled or if unintended consequences of certain public policy like encouraging diesel 10 or 20 years ago is not effectively managed, is that it’s the very young, the old, the most vulnerable who suffer and are effectively driven out of the urban area. High-quality eco-friendly housing—I think that’s probably one of the areas of particular renovation that we have seen. There are some good examples in Wales, but I think we need to realise that Cardiff, Swansea and other cities could really be marketed as places to come to see that carbon neutral, or carbon minus, even—I’m not quite sure if I get that term correct—housing is possible. Deputy Presiding Officer, the National Assembly itself as a building remains one of the most eco-friendly public buildings in the world, and I think we should be very proud of that. Green is best. Green really interests people as well, and if you’re achieving these great national priorities, and being green about it, I think that is a sign of great quality, which is not overlooked when people come and see us in action. I was interested that some American cities now are turning very much to this concept of marketing themselves as green spaces and areas where there is this great potential for a green economy. Pittsburgh, which some of you may know, in Pennsylvania, this old steel-making town and a coal mining area around it, and was for many years regarded as perhaps the hardest city to turn around, has now gained much in recent years from marketing itself as the USA’s greenest city, or the greenest emerging city, and it has stressed that it has the first green convention centre, the first green children’s museum and the first green public arts facility. I think that’s the way we need to be looking at, for example, Cardiff. We can really aim for that and be leading the way in Britain and, indeed, in Europe.This brings me on to the whole concept of design quality. There are some cities around the world that have invested in design particularly, so they, for instance, give support when people are designing whatever it is—small housing estates, public buildings or commercial buildings. You can have help hiring architects, for example, that will place a lot of emphasis on the design quality. Those are the sorts of schemes, I think, that we need to be looking at.Can I turn now to transport, because I think this is, perhaps, one of the things that traditionally has let down a lot of cities, because of the choices that were made after the second world war in particular? But there’s also a lot of hope with new modern systems that are available to us, and technology also improving. I think public transport is itself enjoying a remarkable comeback as people see the advantages—a lot of people don’t really need to own and run a car. I’d be delighted if I could get rid of my car. It’s not quite feasible, given my job at the moment, but living in Penarth, it would be quite feasible for me to have a very full life without a car, just relying on public transport or occasionally hiring a car if I needed specifically to do that, and also relying on active transport like walking and cycling. The south Wales metro offers a great prospect of an integrated transport network that will do much and do much for some of the poorest in our society. The upgrading of the Cardiff rail network and the resignalling that’s going on—. Just another point here on transport: electric vehicles will revolutionise much of what happens, not only cutting pollution, but you’ll need a new tax base, for a start, because you’ll no longer be able to tax petrol and diesel. It is likely that concepts like road pricing—I’m not talking about ridiculous levels, but that’s more likely to be the way that motorists will get taxed, and that opens up all sorts of possibilities of managing more effectively the flow of traffic in cities.I want to talk now about citizen involvement, because I think that’s something that is at the very heart of achieving the sort of change that citizens really want, and giving back urban places to people, to our citizens, because I think there was a trend not to see the citizen as central, really, to the life and work of cities. Here, I’d like to stress some schemes we’ve had for a while now, but I still think they are very, very effective—community asset transfers, for instance. I was pleased to see recently that the Welsh Government is stressing the need for best practice here to be more aligned with the objectives of the Well-being of Future Generations (Wales) Act 2015, but it can empower communities, and I think it’s very, very important. Incidentally, there, I would like to see systems whereby we can get, perhaps, some of the wealthier neighbourhoods to twin with some of the poorer ones and transfer some of the knowledge base that they have, and perhaps some of our grant mechanisms ought to be depending on that type of lateral thinking.Neighbourhoods, I think, should be involved in identifying priorities. Is it litter reduction? Is it ensuring safety and perhaps having a few more police on the beat? Speed limits—perhaps they’ll want a 20 mph speed limit as a top priority in their neighbourhood. Why, indeed, do we have 30 mph as the assumption in urban areas? Why should it not now be 15 mph or 20 mph? Or they may emphasise playgrounds. I’d like to commend here the work that’s been undertaken in Atlanta, Georgia, which has made citizens central to their urban strategy. They call it the Atlanta BeltLine, where they try to integrate transport, open spaces, public art and affordable housing—all taking note of and involving citizens and the citizens’ priorities.Can I conclude by saying that I think the policy framework is pretty strong, but we need to make sure that it’s integrated and works together effectively? The future generations Act, I think, is very, very important. Co-operation with the UK Government: we look at the Cardiff city region deal, for instance, and the Swansea bay and the north Wales growth deal. These are very, very important developments. Vibrant and viable places: I agree with the main focus there, with job creation and investment to be levered in, and people assisted into employment. So, there’s good scope there, but I think now that we need to raise our ambition also. Our cities can not only be best in class, they could be amongst the best in the world. There’s a lot of potential, but there’s also a lot of competition, not only internationally, but within the UK. I do believe that there’s going to be a profound adjustment in the levels of economic activity currently crowding into the south-east, as a lot of those in the new generation—those people who can’t afford family homes—will be wanting to move to places where they can enjoy a much better quality of life. So, I think, for all these reasons, we should be optimistic, but we should also realise that our game needs to be raised, and our ambition greater. Thank you.

I have selected the amendment to the motion. I call on the Cabinet Secretary for Economy and Infrastructure to move formally amendment 1, tabled in the name of Jane Hutt.

Amendment 1—Jane HuttAdd as new point at end of motion:Notes the proposals of the Welsh Government contained in Taking Wales Forward to develop a stronger and fairer economy and recognises the importance of measures to develop sustainable regional economies that serve every community across Wales.

Amendment 1 moved.

Ken Skates AC: Formally.

Jeremy Miles AC: I welcome this debate. I think it’s a very timely debate, given the discussions we have ongoing in Wales about the role of cities and the role that cities can play in regenerating regions of Wales. I want to make the case for two approaches in this discussion today. The first is the case for looking at city regions, not just cities themselves. I obviously speak as a Member for a constituency that is within one of our city regions, but not at the geographic centre of it. So, these issues are important to those constituents of mine who are looking to this debate for economic opportunities in the future.The strategy focusing on cities is based on the idea of agglomeration: that the more businesses and economic activity you have in geographic proximity, the more likely you are to have growth. That is a very well-established economic theory. It’s not without its doubters and, in some sense, it’s increasingly contested with the role of technology and digital connectivity and so on. There’s a question as to whether that geographic, physical proximity is still the glue that has been so useful in the past. But it seems to me, whatever the outcome of that debate is, the idea of a city region where you have a core city that drives economic growth, from which we hope policy will then spread out to the surrounding areas, is clearly, it seems to me, a commonsense, practical way forward.The other aspect that I want to make the case for today is that the kind of growth that we see in cities and city regions should be inclusive growth, where all the residents are able to participate fairly in the opportunities that come from successful economic policies and successful economic activity. I would draw Members’ attention to a report published only yesterday by the Joseph Rowntree Foundation into inclusive growth in cities. Just as David Melding was citing a number of international examples, the JRF looked to cities like Barcelona, Helsinki, Malmö and New York for some of their successful strategies in ensuring that all residents are able to participate in growth.There have been two broad strategies. One is better distribution of the existing opportunities, which is through better, enhanced connectivity, be that transport or be it digital connectivity. The second strategy—perhaps a more ambitious strategy—is to try and change the economic model itself to try and change the nature of the jobs market, the labour market locally, and really focus on increasing the number of semi-skilled job opportunities. Those cities that have succeeded have used a blend of reasonably well-established policies, for example, promoting the use of social enterprise in the local economy, using social clauses in the public procurement process, and place-based intervention, which David Melding touched on, which looks at all the expenditure, for example, happening in a particular neighbourhood or a particular part of the city region, and looking intelligently at how that can be spent to perhaps achieve greater impact.The last point, very importantly, is the question of engaging citizens. That can be from a commissioning point of view. Lambeth, for example, has taken the very bold step of creating a co-operative to deliver youth services, for example. So, there are some very bold examples out there. Building on that, I just want to look at one particular aspect, which is the role of public bodies in our cities and city regions, and the capacity they have to drive some of the things we’ve been touching on today. Often in Wales, people comment on the scale of the public sector being larger, proportionally, than in other parts of the UK, and usually that’s commented on in a negative way, but actually it’s one of our assets. Public services deliver public services, but they are also significant economic actors in their local economies. And if you look at them as anchor institutions, I think we should be looking for a framework where they procure not on the basis of the cost of the contract, or even really on a transactional basis, but more ambitiously, looking at how their economic activity, perhaps in conjunction with other public bodies, can actually nurture local supply chains and develop local suppliers. That will require collaboration between the health boards and the universities and local authorities, but I think we should be looking for that sort of ambition. We’ve seen examples of that in the States, for example, in Cleveland, where that has worked successfully.I would also like to see us looking at the data that are available to us in terms of public expenditure. We should be in a position to look on a postcode basis at all the public expenditure happening in that area, and seeing what we can do to make sure that is getting as much impact as it possibly can. Lastly, briefly, again on the question of data, wouldn’t it be fantastic if we had an opportunity to make available all the data that we have about how our cities and our city regions work, to hand that over to the public and ask people to bring their ideas as to how they can improve—or how they can ask public services and the Government to improve—the areas in which they live? So, I think there is an agenda here that is an imaginative agenda, and I hope that Welsh Government will take up some of these challenges.

Suzy Davies AC: Thank you, everyone, for taking part in this debate. I’m pleased to take part as well. I think it’s going to be a rather thoughtful debate about what we want urban Wales to look like, not just literally, but philosophically as well, because this is very much about the place of the citizen in designing our environment. While I want to speak directly to the motion today, I did first want to reference yesterday’s debate and the contributions made on air quality, simply because I want to reinforce a point about political will. David Melding mentioned in his opening contribution the frameworks, but frameworks only go so far, and without political will, really good ideas don’t happen. I’ll just give this example: Members may well remember my protestations about the airborne gunk that finds its way periodically in through my bedroom window as it crosses Swansea bay. There are some mornings when I really feel like an Emily Brontë tribute band, I must admit. But this same airborne gunk surrounds our glorious new university building in Jersey Marine. It affects our world-class tourism attraction: our fantastic south Wales coast. It’s the same fug, basically, that creeps across our seaside cycle paths. It mingles with exhaust fumes when I’m sitting there in traffic playing join the dots with the many, many traffic lights that seem to infest Swansea city centre. None of this does anything to stir life into those nowcaster diversion signs that cost us all £100,000 to help us avoid areas of high pollution. They’re still functioning as very little more than rather dull roadside sculptures. So, when Simon Thomas yesterday said that Governments really need to take their environmental regulation enforcement responsibilities seriously, he was right. Those enforcement opportunities aren’t just like the nowcasters—just decorative things on the side of the road. It isn’t all about regulation, either. I think it would be a mistake to play down the opportunities—responsibilities, even—of our citizens, and that’s not just for things like recycling, as we rehearsed here last week, but about those plans to improve amenities as indicated in the motion, and as both David and Jeremy have mentioned. It’s a week when we’ve been discussing the difference between people and prerogatives and Parliament and the Executive, but we can’t just demand a right to be heard if we’re not prepared also to take our responsibility seriously to do.I think there’s another debate here to be had about what consultation looks like, but it’s part of a much bigger question, which this debate touches on, about citizen engagement as a gateway to citizen participation. Are we raised as a population to think that our surroundings are somebody else’s responsibility? Are we raised to think that we should do something about it? Is it somebody else’s job to worry about it? Have we reached a stage where our citizens don’t have confidence that our ideas are valuable or relevant or influential?I think it’s worth remembering that the driving philosophy behind the Swansea city of culture bid was that it would help to change how we think about our environment and our communities, and make them part of tackling problems rather than abandoning those problems to be solved by councils. I think the Swansea bay tidal lagoon is a good example of what I’m talking about. Political will has been galvanised, not just by academic arguments but by creating advocates out of the people who live locally—getting them to think about a big new idea in quite a complicated policy area and believing that they were powerful enough, brave enough and confident enough to help to make this visionary change. The same may well be true for electric cars in due course, David.I think this motion, which suggests that the city region concept is central to regeneration, might well be correct, but I think that both the bids in Wales could learn a thing or two from the story of the lagoon about bringing citizens right into the heart of visionary change. That visionary change can be very neighbourhood based, of course. I understand that the Welsh Government is publishing a housing report soon. If that doesn’t talk about making citizens part of housing policy by encouraging them to think about how they’ll plan for their needs over a lifetime then I’ll be disappointed. I’ll apply the same to town-centre planning, if you like. Some of the Vibrant and Viable Places plans in my region reflect elements of this. They’re not just about affordable high-street starter homes and then nowhere to go. Thought has been given to real lives, to intermediate rental properties, as well as to accessible downsizing properties, so that people can find new homes in later life in a familiar community, freeing up larger properties to allow new families in, reinvigorating community cohesion and, of course, encouraging new participants in the local economy.But just when I think that the real needs of real human beings are starting to be very visible at the heart of a big transformational idea, it runs up against the blunt instrument of target-driven local development plans. Maybe the citizen isn’t quite yet powerful enough to make all visionary changes when Government policy development data-gatherers are switched off to those important data that really are central to informing political will. Thank you.

Neil McEvoy AC: I declare an interest, because some of the matters will touch on Cardiff, and I’m a Cardiff councillor. I’d also like to wish everybody ‘Diwrnod Santes Dwynwen hapus’—happy Santes Dwynwen Day. I hope everyone’s taking their partner out tonight and will treat them very well to a meal and so on.Back to this—green cities. I welcome the debate on green cities. My party will be supporting the motion, but I think that, if Labour vote in favour of this, it’s going to be the ultimate hypocrisy, really. It’s true that the international trend is to evaluate cities on liveability, green, and sustainability criteria, but that’s not happening in Wales. Labour councils up and down Wales have planned to destroy greenfield areas through local development plans, as my colleague over there mentioned. But I think that local destruction plans, as they’re more accurately known—. Here in Cardiff, there are plans to build tens of thousands of dwellings on green fields. It’s going to ruin access to clean open space, it’s going to destroy ancient woodlands, and it ends any hope of effective traffic management within this city, because there will be at least 10,000 extra cars on the roads. With ‘carmageddon’, you can forget all about air quality. There are so many people already dying from air pollution in Wales, and Labour’s plans in this city will ensure that more people die before their time, because air pollution is the new smoking. Citizens’ involvement in local development plans all across Wales has been ignored. Again, in this city, the Labour Party was elected to protect greenfield sites—they said they would. It turned out to be a lie, because, within months of winning the 2012 election, they announced plans to build over huge swathes of green fields in the west of this city. Consultations were held in Cardiff, and almost everybody rejected Cardiff’s local development plan. There were referenda, thousands—thousands—of people voted against the local development plan, but they were ignored.The centrality of the city region concept is non-existent, with these very disjointed plans all over Wales. Local councils are ploughing ahead without any regard to the city region here, without any regard to what is happening in neighbouring authorities. Thankfully, through the activity of Plaid Cymru activists, Caerphilly’s LDP was thrown out. In the Vale, our councillors have huge concerns there as well about Labour’s plans to destroy countryside. In the north, Bodelwyddan will be consumed by a new housing development, the green fields will be gone, and maybe the Welsh language will go also. Regional planning is the solution, but the simple truth is that it’s not happening. The thing is that Labour just won’t address the issues, either. When I raise the local development plan in Cardiff, I’m smeared as being an anti-incomer, even by the First Minister. Is that what Labour think about the thousands of people who voted against the local development plan in the referenda votes? I’m a localist, and I put my constituents first. We should be catering for local need, which is common sense—and it makes sense environmentally as well. I look forward to seeing how the Government votes on this motion, and if they’re prepared to support a Conservative motion here calling for green cities with open spaces then I can only assume they’ll be supporting Plaid Cymru’s motion tomorrow evening on Cardiff Council, calling for the local development plan to be revoked, because we want to protect the green fields and green spaces and green lungs of this city. Because if you vote for one, and your colleagues across the road vote against the other one, then that just reveals a huge hypocrisy, really. I think, really, it would dispel any kind of idea that your party believes in sustainability at all. We won’t be voting in favour of Labour’s amendments, because we don’t vote for empty words. You do one thing in here—you talk about air quality—and yet you’re going to put 10,000 extra cars on the roads, with no public transport infrastructure. The metro is years ahead, and we’ll see if that even materialises. What we should be doing in this city is looking at green solutions, how everybody can live in Cardiff and enjoy our city, rather than just dumping houses on greenfield sites and destroying communities, like it’s the 1970s. We’re in the twenty-first century now, and we should all be thinking about how we can protect our local environment, and live in truly green cities. Diolch yn fawr—thank you.

Nick Ramsay AC: I’m pleased to speak on what I thought was a consensual motion—I’m not so sure now, having listened to Neil McEvoy’s comments, but, hopefully, all parties in this Chamber can come together around certain key tenets of this motion. This has been an historic week, after all: the fiftieth anniversary of the creation of Milton Keynes new town—a brave new world of freedom, or the frustrating godforsaken land of the roundabout, depending on your viewpoint and your opinion of what we’re trying to achieve in our cities, and have been since the war. We debate many different issues in the Chamber, many of which have an impact on people’s lives—some more than others. But the environment immediately around us plays a profound role in our lives, in our development as human beings, our happiness and our well-being. It’s because of this that urban renewal and regeneration is so closely linked to well-being, and has been recognised to be so for such a very long time, going back to the development of the first garden city in the UK at Letchworth, in the early 1900s, and then again revisited in the renewed post-second world war development of new towns in the new town programme of Clement Attlee’s Government. We’re today debating this subject in this incredible building, referred to by David Melding in his opening remarks as a beacon of sustainability, in Cardiff Bay, in an area that has been transformed as a result of inner city regeneration polices begun in the 1980s, spearheaded in those days by one former Environment Secretary, Michael Heseltine. So, this is probably a very appropriate venue to discuss where we go from here and how we make the most of our urban environment in Wales and deliver the type of benefits we know are within our grasp, with the right approach and the right mindset.I think it’s fitting that we’re debating this in the wake of the historic signing of the Cardiff capital city deal, so important for the regeneration of parts of south Wales, such as the south Wales Valleys and, indeed, some of the poorer parts of our rural areas, so often neglected when we consider regeneration. It’s not just an issue of regenerating urban areas; our rural areas need regeneration as well and, as a result of the city deal, their destinies will be in many ways linked. David Melding set the scene for this debate with a wide-ranging introduction. If I can just focus on the transport aspect of the debate, which he did mention and, specifically, the transport element of the city deal, because they’re closely related, I think, first and foremost, the Welsh Government must do more to promote walking and cycling in Wales. This, at the end of the day, takes the strain off other transport, forms of transportation, higher up the chain. So, if you can’t get the walking and cycling right, we can’t get the other aspects right, either, because they’ll be overly relied upon. Infrastructure improvements must be made if the Cardiff city region is going to successfully promote green travel, and it’s been a while now since we passed the Active Travel (Wales) Act—I think it was back in 2013. As Chair, then, of the Enterprise and Business Committee, my concern was that the Active Travel (Wales) Act would languish on a shelf somewhere, not actually improving things out there in our communities. Okay, well, we’re two years in and I think the jury is still out on how successful it will be, but I think one thing we all realise increasingly is we do need that Act to succeed; we do need walking and cycling to be promoted and encouraged. The former Enterprise and Business Committee also looked at integrated ticketing—as Professor Stuart Cole described it, a devilishly difficult thing to achieve. Integrating services makes travel on public transport simpler, flexible, and more convenient for passengers, who can have a seamless connection between bus and rail travel. In that situation, passengers would have a greater knowledge of how extensive public transport can be in their area and it can encourage more people to begin using public transport. Sadly, as we know, pilots like Go Cymru were scrapped before they could really get going—pardon the pun. In future, we do need to develop more integrated ticketing, whatever form that may take, and new technology will allow for new forms of integrated transport of a type we haven’t really yet considered. I would say, in moving to conclusion, that Neil McEvoy painted quite a bleak picture of where we are at the moment in Wales, and in Cardiff specifically. Well, if you think things are bad now—you did mention the 1970s, Neil, and it’s hard to believe that the Buchanan report, back then, advised the opposite to what we’re talking about now. That advised the closure of railway lines in Cardiff, the demolition of thousands of houses, and the creation of an urban motorway network, including the notorious and hated Hook Road. That was so extensive, all of that would have taken until 2001 to complete. Only Eastern Avenue in Cardiff was actually finally built of that programme. So, I think the moral is that planners aren’t always right, Governments aren’t always right, but I think Governments try, and I’m sure that this Cabinet Secretary will do his best to make sure that we don’t repeat the mistakes of the past, that we take stock of where we are and we move on to a brighter, better, greener, more sustainable future.

Gareth Bennett AC: Thanks to David Melding for bringing the debate today. A lot of the issues under discussion today were also touched on, to some extent, in yesterday’s Government debate about creating better local environments. These terms ‘creating better local environments’ and ‘liveable cities’—this kind of thing—I do find a rather all-embracing subject matter, so it is sometimes difficult to know where to start in these kinds of debates. The motion specifically mentions city regions as drivers of economic development, which theoretically, yes, could be a central concept, although it’s not a new idea, as the coastal cities of Cardiff and Swansea always had their economic hinterlands in the Valleys, where the iron ore and then the coal was being mined. So, the city region concept is, up to a point, merely recognition of these long-established economic hinterlands. The problem is that, since the closure of the extractive industries, like coal mining, more and more people living in the Valleys have been obliged to travel down to the cities for work. This is causing major problems of road congestion and overcrowding on trains. In the Cardiff city region, we know that the metro is coming at some point, so this may ultimately alleviate these problems. But, in the meantime, travelling into Cardiff is something of a nightmare.The dreadful congestion also worsens the air quality for everyone, including the city’s residents, which we were discussing yesterday. Tree planting and other schemes can alleviate this problem, but I fear these programmes will ultimately provide only a small mitigation from the extra environmental pressures caused by major house building in Cardiff suburbs, much of it, indeed, on the green belt, as Neil McEvoy was just alluding to. And although his synopsis may have appeared bleak, I must confess I do share most of his foreboding about the future for Cardiff. The house-building programme is caused by the city’s population expansion. Is this expansion a good thing or a bad thing? To me, it appears to threaten the very liveability of the city as green spaces disappear. So, on reflection, I don’t regard it as a good thing. The house-building programme: does it even bring much in the way of affordable housing, another issue mentioned in today’s motion? Well, often, alas, it does not. Most of the housing schemes are largely private developments with only a small element of social housing. Yes, we know there are cycling and walking schemes being pushed by the Welsh Government as part of their active travel programme. But this clashes with the reality of successive school reorganisations forcing parents to send their kids to schools further and further away—hence the traffic chaos of the school run. I note that schools do have the ability to be flexible with the time of the school day. I wonder in what ways local councils can encourage them to do this more often, because this could help mitigate the congestion if enough schools could be persuaded to be more flexible. Another major impact on population expansion is the rapid increase in the student population, which also takes up a lot of space and is by no means a development to be unreservedly welcomed. Many students drive these days, hence more traffic and parking problems ensue. We do acknowledge that the aims of the Conservative proposal are laudable ones. Hence, we in UKIP support the motion. But we do also have to acknowledge that it is often difficult to translate laudable aims into effective practical measures. Thank you.

Janet Finch-Saunders AC: Wales’s population is expected to increase dramatically over the next decade, with the number of elderly persons over the age of 85 expected to double. The suitability and practicality of our urban design, our housing and the transport connections of our towns and our cities to fit this demographic need must continue to evolve in line with growing need and greater expectation. Age Cymru have highlighted the requirement for public buildings to comply with specific access considerations, especially for those with disability need or sensory impairment. The demography of our ageing population is fast-changing and Government must move at a similar pace. In order to cope with increased congestion and more commuters, the Welsh Government must do more to promote walking and cycling in Wales. The Welsh Government must fully embrace new technologies and invest in the future of a modern transport infrastructure on a Wales-wide scale, not just in Cardiff. An essential enabler for many of our older population is access to robust and reliable public transport providing connections between our rural communities, urban areas and public services: hospitals, libraries, community centres and shops. Transport that is effective and accessible to all is essential to eradicate the impact of isolation, loneliness and despair. The housing crisis must be confronted if Wales is to cope with population demand in our cities, but also in our towns. Furthermore, measures must be taken to guarantee that all new housing projects are energy efficient and adapted to the needs of the local demographic. The Well-being of Future Generations (Wales) Act 2015 is designed to bring about a new and exciting agenda of change. So, we do need schemes to improve the energy efficiency of our existing housing. We need measures to reduce the current rates of fuel poverty. The average dwelling in Wales falls within energy performance certificate band D, which is not high enough to protect households from fuel poverty. Here in Wales, 23 per cent of households—that’s 291,000 homes—were estimated to be in fuel poverty in 2016, a lot of this in Cardiff. That is more than twice the percentage of those in England. The future generations Act should be used as a lever to work in tandem with Nest to offer support to UK Government initiatives that have been successful in reducing energy poverty, such as the energy company obligation, ECO. So, any new properties in our cities—in Cardiff or elsewhere—should actually be fuel-poverty-proof. The Conservatives, in 2013, brought out a scheme that provides obligations upon energy suppliers to provide energy-efficient measures to households across the UK. This is important to help us to reduce our greenhouse gas emissions, for which the residential sector in Wales is responsible—a quarter of our annual 3 per cent reductions target. This week, I’ve been doing some work on air pollution and, again, for our towns and cities it’s vital that, as we grow them, we don’t grow the pollution that comes with them. I welcome the provisions of the Wales Bill, which will give the Assembly the opportunity to develop a specifically Welsh feed-in tariff scheme to support the installation of solar panels. Welsh Conservatives have warned against an overdependence on wind energy, and we wholeheartedly welcome the findings of the Hendry review in its support for tidal lagoons in north and south Wales. Our cities and urban areas will be some of the key drivers for Wales’s economic resilience and prosperity in the years to come, and it is essential that the Welsh Government works to ensure that they are suitable to the longevity and well-being of our unique demographic here in Wales. In welcoming the city status in particular, I would just like to add St Asaph in north Wales, the little town that became a city. Having passed the legislation for the Well-being of Future Generations (Wales) Act last term, I believe it is incumbent on us as politicians not to be looking to duplicate legislation or further complicate the aims of this Act. Fully interpreting, implementing and adequately resourcing the aims of this Act by this Welsh Labour Government will, in my opinion, move Wales forward in great strides. That is in our urban areas, our rural areas and certainly in our cities. Thank you.

I call on the Cabinet Secretary for Economy and Infrastructure, Ken Skates.

Ken Skates AC: Thank you, Presiding Officer. I’d like to thank the Conservatives for tabling this debate today and welcome David Melding’s introductory contribution, along with his acceptance of the Government’s amendment. I’m just going to quickly pick up on his final point, because I think that’s particularly important, and that concerns citizen involvement, which was raised by a number of Members around the Chamber, of course. Citizen involvement is of immense importance to people because it conveys a sense of control over their lives, over their environment, over the place that they value, their town, their city, and it relates to, of course, Maslow’s hierarchy of needs where control is a fundamental need of every person if they are to live in a way that eases despair and anxiety and that embeds a sense of well-being in their existence. Of course, it’s reflected as well in the well-being of future generations Act the ways of working in which consultation with the public is provided as an essential component of all the decisions that public sector bodies should be making. I think that a number of important issues have been raised today by Members, and I’d like to address each one. The first is the very important question, I think, and that is: what role do our cities and also our other major urban areas play in supporting economic growth? Well, we’ve long recognised that cities are fundamental in driving a nation’s prosperity, given the abundant evidence. It demonstrates how larger urban areas generate economic growth faster than rural areas. We first recognised the potential for city regions back in 2011 when we commissioned a report and established an advisory group to consider the evidence for city regions, and this led us, of course, to setting up the Cardiff capital region board and the Swansea bay city region board undertaking the foundation work that has led to the city deals being developed. Of course, deals offer Wales and our regions an important opportunity to unlock additional Treasury funding to support interventions that can deliver economic growth, but deals should not be seen simply as project delivery and funding vehicles. They offer an opportunity for citizen engagement and they are critical tools in providing a framework that allows regions to drive a new way of collaborative working, setting priorities as a single voice that supports local economic ambitions and objectives and, of course, delivers key functions at a strategic level. They are critical to realising the vision of genuinely sustainable, clean, well planned cities and wider regions that the motion points to. Genuine collaboration amongst stakeholders and local authorities in particular as a consequence of the deals should not be underestimated if we are to achieve the vision of lovable, prosperous cities—cities that we’d wish to see defined not just by how wealthy they are, but also by the quality of place that they command, by how urban environments can enhance rather than inhibit well-being and happiness levels. I think each of the points within the motion are proven to contribute to this.Many examples of cities around the globe have been quoted today. We could actually celebrate close to home, right here, the fact that Cardiff is known as one of the best places for young people to grow up in. We have just next door the Wales Millennium Centre, which has received an award for being the friendliest theatre in Britain. I think it’s fair to say that we would wish to see our cities and towns known as the friendliest places that people can visit, because that’s what’s going to draw people here from places like the south-east, that David Melding pointed to, which will grow and expand to a point where many younger people will seek out other cities and other towns to establish families and seek work in. So, we need to make sure that our cities and towns are amongst the most attractive places in which to work and live.

Andrew RT Davies AC: Will the Minister take an intervention?

Ken Skates AC: Yes, sure.

Andrew RT Davies AC: I’m grateful to the Minister for taking the intervention. Will he recognise the importance of this regional type of planning and, in particular, making our cities and towns very attractive? Because with the directly elected mayors now that have huge regeneration powers and responsibilities in Bristol, Birmingham and Liverpool, right across the border—north, mid and south—there are going to be these engine rooms of redevelopment, regeneration, directly controlled locally by those cities.

Ken Skates AC: I think whether it’s through directly elected mayors or other forms of policies, it’s essential that you have democratic processes that convey a sense of control by the citizen but that are also streamlined, efficient and effective. That applies not just to cities, but also to more rural areas, I believe. But of course, we also have to recognise the limits of cities as much as their potential. I think it’s fair to say that, looking back over the last few years, the Welsh economy has performed exceptionally well. We know that unemployment is at a record low, that employment is at a record high and last year, the Welsh Government helped to create and protect 37,500 jobs. So, there’s no doubt that parts of Cardiff and Swansea and other large urban areas have achieved impressive growth. But, as I’ve said today in an article in the ‘Western Mail’, I think our challenge in 2017 is to build those fundamentals of a strong economy in all parts of Wales and our approach must go beyond, in my view, simply focusing on developing our cities to a more nuanced approach that better reflects the needs and the opportunities for economic resilience and prosperity right across Wales. This is something that was recognised in part (h) of point 3 in today’s motion, which several speakers have touched on, including Nick Ramsay, who also championed, rightly, the need for integrated ticketing—and I do believe that with the new franchise and the ability of Transport for Wales to control the ticketing mechanisms, we will be able to realise that vision that has eluded us in many places.I think it’s also essential for us to support economic growth and prosperity in a way that recognises that Wales’s economy has a significant regional dimension, again raised by a number of Members. In doing so, I think we need to grow our regional capitals—those towns and large urban areas that are not necessarily cities, but that are major attractive areas that can have the potential to create the sort of agglomeration that Jeremy Miles spoke of, which acts as a driving force for economic prosperity.I think it’s also essential that we do all we can to share the wealth and to address head on the structural and economic problems that still blight too many communities. That’s why we’ve not only encouraged and supported the development of city regions and city deals, but also have been strong supporters for the work of the Growing Mid Wales partnership, the north Wales growth deal and north Wales’s relationship with the Northern Powerhouse.In north Wales, of course, there’s an opportunity for greater collaborative working within the region and across the border, and it’s something that I am very much encouraging. I think the debate today has touched on some very important themes, and it’s clear that a co-ordinated and cross-governmental approach is essential in achieving growth and prosperity right across Wales. One final point—and it’s something that Janet Finch-Saunders raised in her contribution—is the importance of how the built environment should be designed and constructed to reflect the needs of an ageing population. I believe that Janet Finch-Saunders is absolutely right, and I would go one step further and say that design should be based on a people-first basis, not at all on a vehicle-first basis. For that reason, I think Nick Ramsay is absolutely right in his assertion that the active travel Act must be successful.

I call on David Melding to reply to the debate.

David Melding AC: Diolch yn fawr, Lywydd. Can I thank everyone who has taken part in what I think was a very constructive, insightful debate? And lots of common themes have emerged. Can I just start with Jeremy Miles? I think this point that technology can out-trump geography is correct, but I think the other side of that is that it has made all of our urban areas a part, then, of the actual cities we’re talking about: Neath Port Talbot into Swansea, but by the time you get to Bridgend, it’s Swansea or Cardiff. This is, I think, a great liberation. Gareth Bennett made this point that we’ve always looked at the hinterland—that is true—but now I think it’s much more on the general urban offer, rather than extractive industries in particular. And cities are very popular. I think that’s one thing we’ve really got to remember—very popular with younger people; that’s where they’re moving, generally. Jeremy also talked about this concept of involving citizens and inclusivity, and it was picked up again, by several of today’s speakers, but the Minister mentioned this as well and related it to well-being. I think that’s really important and is something I completely agree with.Suzy talked about her own direct experience of poor air quality and pollution wafting over Swansea bay, and mentioned the great new university campus on Swansea bay. It was remiss of me not to mention universities, because they really are key players in our cities. But, yes, this is a real issue. You mentioned the citizen engagement in the tidal lagoon, and I think those of us who listened to Charles Hendry earlier—he said that it was one of the remarkable things that there was obvious citizen support for the concept.Neil McEvoy, I think it’s really important that we preserve green areas, and I’m glad you mentioned woodlands, because I think urban woodlands are very, very significant. However, I think cities have to develop. We do need more housing and I think Janet mentioned the housing crisis. But perhaps we need to ask questions now, and engage with the people who are going to be, say, in their mid or late thirties in 10 years and say, ‘Well, what sort of housing offer would be acceptable to you now?’, because we will have to change. The old view of a fairly large semi-detached house with grounds surrounding it: we can’t build that sort of dwelling. It may be more—. An alternative is a more densely compact one, but, still, it’s bigger than what we have at the moment. A lot of apartments are not suitable, really, for family life. Go to the continent: large apartments. You go to one of the great cities of central Europe—Prague or Vienna—and what strikes you, if you go to someone’s home, is how large they’re apartments are, and then they’ll have a communal garden that everyone can enjoy. That may be something we need to look at, so that we use our land more effectively.Nick Ramsay mentioned Milton Keynes, which is 50; you mentioned the roundabouts, but not the concrete cows, which, I’m sure, was a good choice. Cardiff bay is in that sort of category, I think, in terms of the ambition of its transformation, and I think Milton Keynes, you would say, is actually an example of good planning, generally, but there have been past planning howlers. You were right to mention that. The great Sue Essex, of course, was an Assembly Member in the first two Assemblies, and I believe she was a town planner. She was certainly chair of the planning committee and brought great insight to these matters, but humility, sometimes, is also quite important.Can I thank Gareth Bennett for talking about road and rail congestion? That really is a major, major issue. It can be managed, but, again, it needs lots of flexible solutions. I think the students in Cardiff add a lot to our city. There, the university has been very flexible and innovative in the housing offer, and they’re building some really striking new buildings, and students are quite demanding. Why young people are not as demanding as students about their housing is a mystery to me, but perhaps we should find out.Janet then also mentioned the demographic challenge of elderly and disabled people in particular. We need to remember them in our urban design—very, very important—and she and several others talked about alternative transport—walking and cycling. Can I just say—I go back—we need to look at our road networks again? Some of them should be designated to just public transport. Some should now become cycling and walking routes. We need real ambition to change our wonderful urban spaces so that they will become world beaters.

The proposal is to agree the motion without amendment. Does any Member object? The motion without amendment is therefore agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.

9. 7. UKIP Wales Debate: General Practice

The following amendments have been selected: amendments 1, 3, 4, 5, 6 and 8 in the name of Rhun ap Iorwerth, amendment 2 in the name of Jane Hutt, and amendment 7 in the name of Paul Davies. If amendment 2 is agreed, amendments 3, 4, 5 and 6 will be deselected.

The next item on the agenda is the UKIP debate on general practice and I call on Caroline Jones to move the motion. Caroline Jones.

Motion NDM6214 Caroline JonesTo propose that the National Assembly for Wales:1. Recognises that the majority of patients their first, and sometimes only, contact with the NHS is through general practice.2. Regrets that, despite this, general practice receives less than eight per cent of the health budget.3. Calls on the Welsh Government to prioritise general practice with significant investment in resources, people and infrastructure.

Motion moved.

Caroline Jones AC: Diolch, Lywydd. I wish to move the motion before you tabled in my name. The first contact the most of us have with our national health service is through our GP. Thankfully, for the vast majority of us, this is the only contact with the NHS. There are just under 2,000 general practitioners in Wales working out of the 454 GP practices across Wales. While this sounds like a lot, it equates to just over half a GP for every 1,000 patients. We also have a third of the adult population of Wales who report having at least one chronic condition, combined with the fact that in the last decade GP numbers have remained largely static.We know that the impact of chronic conditions will worsen over the next few decades as the number of people aged 65 and over will increase by about a third. Our GP population is also aging, we now have a quarter of our GPs aged 55 and over. This, combined with the fact that GP training posts are not being filled—

Janet Finch-Saunders AC: Would the Member take an intervention?

Caroline Jones AC: Yes, certainly, Janet.

Janet Finch-Saunders AC: Would you agree with me, isn’t is normally correct for a Cabinet Secretary or a Minister to be present in the debate to respond to you and to all the others of us who want to contribute to a UKIP debate?

That’s not a matter for Caroline Jones. You can carry on with your speech.

Caroline Jones AC: Thank you. This, combined with the fact that GP training posts are not being filled, the fact that many GPs are seeking early retirement, and the large number who are seeking to work part-time due to workload pressures, is a recipe for disaster. General practice is facing increasing and unprecedented pressures. There is a significant and growing gap between the demand placed upon it and its capacity. These pressures are not limited to one area; general practice is being forced to try and cope with inadequate resources, an unsustainable workload, and a workforce under considerable strain across the whole of Wales—[Interruption.]

Caroline Jones AC: I can’t take another one Jeremy, I’m so sorry. Those are not my words, they are comments from the BMA. Both the BMA and the Royal College of General Practitioners have, for the last three or four years, been warning of an impending crisis in general practice. They have both been calling for an increase in GP numbers, but their calls have sometimes been ignored. Yes, the Welsh Government is listening: they launched a new recruitment campaign for GPs in October, but it’s not enough. We need to be recruiting around 200 GPs a year. Instead, we are struggling to fill 125 training places available each year. The new recruitment campaign will help, but it is not enough. The BMA and the Royal College of GPs have both asked for greater emphasis to be given to Welsh students studying medicine at Welsh universities, as those students are most likely to remain in Wales. Cardiff are asking for the equivalent of eight A* at GCSE for their courses. Many of the doctors working in the NHS today have readily admitted that they wouldn’t meet that criteria. We are not asking for a dumbing down of courses, just more realistic entry requirements, and a greater focus on Welsh domiciled students.It’s not just the numbers of GPs we need to increase. We also need a Welsh Government that has a stronger focus on and commitment to general practice and primary care. The majority of the Welsh NHS budget does go to secondary care. Prior to 2004 spending on general practice was over 10 per cent of the total NHS budget. There were ambitious plans for expansion, for new services, competition for jobs, training places were oversubscribed and morale was high. Since then, funding has fallen to between 7 and 8 per cent, and general practice does not have sufficient funds for workforce, premises or services. Over the same period, consultation rates have skyrocketed and more burdens are being placed on general practice by secondary care.A poll conducted by the Royal College of GPs found that 84 per cent of GPs worry that they may miss something serious because of an unreasonable workload, and 92 per cent of GPs worry that a lack of resources is putting patient care at risk. Over half of the GPs surveyed said they either planned to reduce their hours or leave general practice altogether within the next five years. Seventeen per cent of GPs have sought support for work-related stress in the last two years. I know of one GP who routinely has to see over 100 patients during a consultation session. This isn’t good for either patients or doctors. We are seeing the impacts of this strain on general practice throughout the NHS. One of the reasons we are seeing ambulances queuing up outside our hospitals and people waiting more than 12 hours in accident and emergency is as a direct result of an overworked general practice. People who can’t get to see their GP turn up at hospital.Both the Royal College of GPs and the BMA have called for funding for general practice to rise to over 12 per cent of the NHS budget. The Royal College of GPs say that increased spending on general practice could save the Welsh NHS over £90 million by 2020. The royal college figures are based on detailed research by Deloitte. The research shows that increasing spending on general practice across Wales by around £3.5 million each year to pay for things such as more GPs and practice nurses could reduce A&E visits by over a quarter and have savings of around £21.5 million each financial year, rising to annual savings of around £34 million by the end of this decade.Both the BMA and the Royal College of GPs agree that we need to invest and improve the infrastructure available to general practice. We need to make greater use of technology to enhance patient care, speed up diagnostics and streamline services. GPs in Wales are still waiting for the introduction of electronic prescribing, something enjoyed by their colleagues across the border. Electronic prescribing enhances the patient experience, it is safer for patients and reduces the workload on GPs. The IT infrastructure available to the NHS in Wales is abysmal. It’s the twenty-first century and we are still relying on snail mail and fax machines. Improvements, when they do come, are slow in coming. We need to ensure that the infrastructure we have in place is fit for purpose, able to adapt to future need and actually reduces the workload of our GPs, rather than adding to the bureaucratic burden.Colleagues, we are facing a crisis in general practice. A crisis if left unchecked will undermine our entire national health service. We cannot go on ignoring the problem or tinkering at the edges. We need significant investment in general practice, significant investment in people, significant investment in resources and significant investment in infrastructure. But we need that investment now. I urge Members to show our hard-working, or should I say our overworked, GPs that we support them 100 per cent by backing the motion before you today. UKIP will not be supporting the amendments by the Welsh Government and we will be rejecting Plaid Cymru’s amendments. We will support the Welsh Conservative amendment because it adds to the debate and does not detract from the core message I would like to see go out from this Chamber today. We value GPs and general practice. They are the cornerstone of our NHS, and the National Assembly for Wales will do all it can to ensure that GPs have the funding and support they need in order to treat patients in a safe and timely manner. Diolch yn fawr.

I have selected the eight amendments to the motion. If amendment 2 is agreed, amendments 3, 4, 5 and 6 will be deselected. I call on Rhun ap Iorwerth to move amendments 1, 3, 4, 5, 6 and 8, tabled in his name.

Amendment 1—Rhun ap IorwerthDelete point 1 and replace with:Recognises that the majority of patients have chronic conditions that are best managed in the community, and this requires strong primary care with general practice at the centre.

Amendment 3—Rhun ap IorwerthInsert as new point after point 2 and renumber accordingly:Notes that social care budgets have faced significant financial pressures, and regrets that social care’s role in contributing towards primary care health services has been neglected.

Amendment 4—Rhun ap IorwerthInsert as new point after point 2 and renumber accordingly:Regrets that there has been a decline in the number of GPs in recent years; notes that a strong primary care service will require significantly more GPs working alongside other health professionals; believes that other health professionals should complement and add to the service provided by GPs, and should not be used to replace them.

Amendment 5—Rhun ap IorwerthInsert as new point after point 2 and renumber accordingly:Notes that many GPs have chosen to come to work in Wales from outside the UK, and that they may choose to leave if the continuing hostility towards migrant workers continues.

Amendment 6—Rhun ap IorwerthDelete point 3 and replace with:Calls on the Welsh Government to ensure primary care, secondary care, and social care work together to help patients manage their conditions in the community, with a focus on prevention of hospital admissions; and recognises that this will require proper long term workforce planning, investments in infrastructure, and wider government policies to promote good health.

Amendment 8—Rhun ap IorwerthAdd as new point at end of motion:Calls on the Welsh Government to publish regular performance data for primary care, with performance indicators and targets established in collaboration with health professionals.

Amendments 1, 3, 4, 5, 6 and 8 moved.

Rhun ap Iorwerth AC: Diolch yn fawr iawn, Lywydd.I move the amendments tabled in my name. It is a timely and appropriate debate, perhaps not for the reasons the party opposite think. It’s timely because, once again, the party’s new leader has confirmed that his party’s long-term goal is to privatise the NHS—[Interruption]. He has, once again, placed on record his view that he has not changed his mind that the very existence of the NHS stifles competition. So, this debate must be seen in that context. Unfortunately, senior UKIP figures keep on making gaffes when it comes to health. We know that Nigel Farage doesn’t think smoking has any links with cancer. Roger Helmer has called for the NHS to fund gay cure therapy. Last week, the health spokeswoman here spoke against the taxation of cigarettes on the grounds that we haven’t reduced the number of smokers by much. A quick check of those facts: 20 years ago, almost 30 per cent of 15-year-old girls and almost 25 per cent of boys were smokers. Now, teenage smoking is at an all-time low, with just 8 per cent of boys and 9 per cent of girls smoking. Adult smoking has reduced from around 30 per cent to 19 per cent over the same period, but what do the experts know, and what do the statistics show, eh?Leaving aside those points, strangely enough, we support the sentiments of the motion, but we do think it needs considerable amendments to more accurately reflect the challenges and the sorts of solutions that we need within the NHS. Amendment 1 reflects the fact that, in the modern NHS, the majority of patients cared for are, in actual fact, repeat users of the service who require ongoing contact and care with primary health to manage their chronic conditions. This really isn’t about the one-time user whose first and only contact is with a GP.Amendment 2 notes the importance of good social care in contributing towards these goals—something we’ve talked about here this afternoon already—noting the financial pressures that have been imposed on social care, probably as a result of a right-wing agenda not understanding the role of social care and believing that austerity is a consequence-free political choice.Amendment 3: this one’s targeted at the Welsh Government. It notes that GPs will always remain at the centre of good primary service. We note the decline in numbers, although the Government likes to show a different set of figures at times. The facts are clear: we had 2,026 GPs in 2013, and 1,997 GPs in 2015, which are the latest available statistics. Other health professionals are a vitally important part of primary care, but they shouldn’t be used to replace GPs. They should, of course, be used to complement them. We note, from the Royal College of General Practitioners’ calculations, that we need perhaps 400 additional GPs in Wales. It’s a figure we certainly see no reason to doubt, and I draw your attention, of course, to Plaid Cymru’s long-standing position: that we need to move over a period of years towards the employment, training and recruitment of 1,000 extra doctors in Wales.In amendment 4, we return to the contradiction in UKIP’s health policies, by noting that many GPs, surprisingly, are not in fact British, and that if the climate of hostility towards migrant workers that UKIP has helped to inflame continues, they may choose to leave the NHS. I do wonder whether they are serious about—[Interruption.] I’m sorry; would you like to intervene?

Caroline Jones AC: Yes, I would, actually.

Well, I’d very careful what you say.

Caroline Jones AC: I feel this is rich. You constantly make comments across the Chamber about Neil Hamilton not living here, and living in England, across the border, so I think that what you’re saying is quite rich, actually.

Rhun ap Iorwerth AC: Are you able to provide any evidence of that?

Caroline Jones AC: Yes. We’re looking at it on past—

Rhun ap Iorwerth AC: I’ll take another intervention, by all means, or we can return to the subject at hand.

Caroline Jones AC: [Continues.]—on past Plenaries. On past Plenaries. The evidence is there.

Rhun ap Iorwerth, there is no intervention. Carry on with your speech.

Rhun ap Iorwerth AC: There is no intervention because the Member is, quite frankly, being ridiculous.In amendment 5, we become more specific about how primary care needs to improve. It requires a combination of primary care, secondary care and social care working together far more, with investments made in the most appropriate place rather than setting arbitrary percentages, and working alongside wider Government policies that promote good health—for example, heavy taxation on cigarettes. In amendment 6, we note that alongside these investments we really need to have—and this is something I know I’ve discussed with the Cabinet Secretary on a number of occasions, including in this Chamber—the regular publication of as many and as broad a range of performance data on primary care as possible. In order to map the way ahead for primary care, we need to have the tools at our disposal, and that certainly includes having the right and the best data at our disposal. Support our amendments today.

I call on the Cabinet Secretary for health to move formally amendment 2 in the name of Jane Hutt. Before he does so, I’m sure he will want to apologise to the Chamber and to the proposer of the motion today for arriving late for the debate.

Amendment 2—Jane HuttDelete all after point 1 and replace with:Recognises the extent to which Welsh Government continues to invest in primary care services across Wales and the ongoing commitment to work in partnership with GPs and other primary care professionals to improve care for people across Wales.

Amendment 2 moved.

Vaughan Gething AC: Indeed, Presiding Officer. I recognise it’s my responsibility to be here on time, and I do apologise to the proposer and to the Chamber for being late for the start of today’s debate. So, I apologise without hesitation, and I formally move amendment 2 in the name of Jane Hutt.

I now call on Angela Burns to propose amendment 7 in the name of Paul Davies. Angela Burns.

Amendment 7—Paul DaviesAdd as new point at end of motion:Recognises the importance that allied health care professionals play in ensuring that primary care is effectively delivered.

Amendment 7 moved.

Angela Burns AC: Diolch, Lywydd. With some trepidation I’m going to try and pour some oil upon these troubled waters, because we support entirely your motion. No-one can dispute how incredibly important general practice is to sustaining and delivering national health services. We also support the amendments by Plaid Cymru, because you actually detail facts, although I do think that you are very naughty, Rhun ap Iorwerth, for trying to paint us with the sins of our fathers, or the sins of the big brother across the other side of the wall, because here, this party is very, very supportive of social care, and we have demonstrated that on many an occasion. I’d also like to say that, in reference to amendment 5, the Welsh Conservatives have absolutely zero tolerance for anybody who assaults, abuses or shows hostility to any member of the national health service, because it is a crime that is not acceptable on any level.Primary care is vitally important to our national health service. I’m grateful to you for bringing this debate. I do feel that I’m unable to support the Government’s amendment until after the Cabinet Secretary has spoken, because I would like to see what he intends to do to support primary care, because I feel that there’s been a neglect of primary care services. We believe that it should be a leading priority for the Welsh Government, in an effort to improve the NHS. Overwhelmingly, general practices are the first instances in which patients will come into contact with the health service, and consequently are one of the most important aspects of the public’s interaction with the NHS. Despite this, we’ve seen the number of general practices in Wales decline by almost 9 per cent over the last 10 years.Quality primary care is essential in reducing the burdens on our hospitals and emergency services. The more resources we can give our GPs to quickly diagnose and treat patients, the more space we can free up elsewhere in the health service. I think we’ve seen again and again under the Welsh Labour Government that waiting times for treatment and diagnosis in our NHS have lagged behind. I want to make it clear to the Welsh Government, not for the first time, that what is most needed, and yet most overlooked when seeking to rectify this anomaly, is extra investment in primary care. In Wales, our GPs are inspiring in their ability to make the best of what they are given. However, they are too often underequipped and subsequently unable to handle the situation themselves, forcing them to refer their patients to a hospital or specialist. This is an extra pressure on the NHS, and we need to be giving GPs the ability to take as much pressure off the secondary care sector as possible. I’d like to give a couple of examples of where I see this work. This is why we’ve brought forward our amendment about the incredibly important role of the allied healthcare professionals involved in multidisciplinary working in a GP practice. I want to just cite one example, of Argyle Street Surgery in Pembroke Dock, which is one of the largest, if not the largest, general practice surgery in the whole of Wales. Their multidisciplinary working team that they have put together, and have been enacting now for quite some time, has allowed people to be seen by the correct person at the correct time. These are their words, not mine: they say that the benefit it brings to them is that it allows continuity of care by the most appropriate person, and it doesn’t have to be a GP; that there’s been a reduction in admissions, improved patient care and, above all, improved patient satisfaction. They say it allows people to exercise their skills and talents, that it’s led to improved end-of-life care and reduced admissions for patients with cancer and non-cancer. It’s increased, above all, job satisfaction. Their multidisciplinary team—I’ve been to see it, and it is quite extraordinary. They have pulled together a whole raft of people, and they work as this dedicated team that answers the patient’s need. Pembroke Dock has some incredibly deprived areas with people with complex issues and a lot of comorbidity, yet the happiness factor is slowly increasing there, because people understand that they’re seeing, in their own home, an occupational therapist; they’re being able to access a physiotherapist without having to go to the hospital; or they can see the same palliative care nurse who’s going to look after them throughout their entire end-of-life process, not just at the very end, but from the start of that diagnosis all the way through.That’s why I think it is so vitally important that we not only recognise the importance of these allied healthcare professionals, but recognise that a good GP practice for the twenty-first century must encompass more than just a doctor, and the doctors will say this as well. I would like to see the Cabinet Secretary explain to us how he’s going to put forward enough funding and enough training into general practice in order to enable GPs to be able to develop along this way. I appreciate that the clusters are really beginning to work well in some areas, but there’s still inconsistency in continuity of practice throughout Wales, and we need to ensure that a place like Argyle Street Surgery can actually become a template for general practice throughout Wales. Thank you.

Lee Waters AC: I’m always entertained by UKIP debates, because they do paint a picture of a country from a bygone era. I look at the motion that they’ve tabled today and we hear mention only of GPs—we fetishise the family doctor. There is a consistent theme that UKIP paint a picture of the 1950s, and today’s motion is no different to that. It reminded me of some of their most recent policies—the most quirky policies that they’ve come up with, entirely in keeping with this bucolic picture they paint of the British countryside—

Janet Finch-Saunders AC: Will the Member take an intervention?

Lee Waters AC: Let me just develop my point a little. Policies they suggested just six years ago of proper dress in the theatre, repainting the trains in traditional colours, more swearing allegiance to the Queen, cheaper beer and bringing back imperial measures. This is the 1950s, where, of course, the family doctor was the lynchpin of the primary care model. Reading UKIP’s motion today, you’d be forgiven for thinking that they want to recreate this approach to primary healthcare today.But, of course, times have changed. Demand has increased—as Caroline Jones noted in her own opening remarks, the pressure on GPs now is considerable. GPs are seeing more than 50,000 patients a day. This has a knock-on effect on the whole health system. I was in Prince Philip Hospital in Llanelli recently, and they explained to me that the average age of a patient there now is 82 years of age. So, the whole system is under immense demand, and, of course, it has to change to meet those demands.One of the challenges that modern healthcare faces is being able to develop a new system while also running the old system in parallel. So, there will be strains and struggles from time to time, but the new model is gradually emerging. The advantage of the new model is that it respects and elevates the skill and training of a GP, and frees them up to look at the more complex cases, while some of the other things that traditionally a GP might have done, or indeed services that simply weren’t in existence back in the 1950s, are done by a range of allied health professionals.So, for example, we have now in many modern primary healthcare settings paramedic practitioners, prescribing pharmacists, physiotherapists and occupational therapists, all offering tailored support to people at the time that they need it, when often the GP is not able to do so. For example, I mentioned earlier that I welcomed the Cabinet Secretary to the Kidwelly surgery of Minafon recently, where we saw a prescribing pharmacist working part-time in the surgery, who’s been able to do a review of all patients with asthma in the practice, to review their medication and to provide them with advice, which is something a GP-led model only would not have been able to do— they just simply wouldn’t have had the time. And also, we need to pay heed to the principles of prudent healthcare—that you only do what only you can do. And I think that this new model plays perfectly into that philosophy.Of course, there are challenges in being able to replicate this model. As we heard the health Secretary say earlier, there are only 15 managed practices currently in Wales, and obviously when you are managed by the health board, you have greater freedom and flexibility to be able to innovate, and to be able to start from scratch and reassemble a model fit for purpose. The system is going under organic change. I have spoken to GPs in Llanelli recently, who are having recruitment problems—they’re having doctors going off on maternity leave, they’re having huge problems recruiting, and locums, for example, are now demanding £1,500 a day in some cases in order to meet the needs of a practice, and they’re telling the practice what they will do, what hours they will work, what things they will do for that money, and holding them to ransom. So, there are huge strains that GP services have, and the GMS contract model is under huge strain and does need to change. And that’s why I think the UKIP motion is misguided, because it is basing its premise on a model that is slowly crumbling away.We’ve heard mention from Angela Burns about the cluster model, which she said is patchy, and I think that one of the challenges the cluster model has is to try and encourage those GPs operating within the current contractor model—and something that people from outside the NHS often forget is that this is, in a sense, a private business still for many—these GP clusters need to encourage these practices to come together, to merge, and only in some parts of Wales is there support available for those GP services to do it—support for IT contracts, for finance, and so on. I think Aneurin Bevan and the ABMU currently provide a service to do that. And many GP practices, because of the sheer volume, simply don’t have the space to be more strategic. And that’s back to the point I was making earlier—we have the challenge of developing a new model of health care, while also running the existing model of health care, which is under huge strain. So, I think it is time that UKIP left the 1950s, joined us in the modern world, and accepted that the GPs—[Interruption.] Sadly, David, I’m out of time.

David J Rowlands AC: Will you take an intervention please?

Lee Waters AC: I’m out of time, I’m very sorry.

David J Rowlands AC: Won’t you take an intervention?

Lee Waters AC: There’s an echo here. I’m out of time, sorry. And accept that the new model can’t simply rely on GPs, as in days of yore. Thank you.

Janet Finch-Saunders AC: Thank you to the Member for bringing this motion here today, and you did so in a very eloquent and balanced manner. I welcome this debate, which highlights the absolute importance of the role of our GPs, and I have no fetish—as the Member suggested that my colleagues have in UKIP—about GPs, but they are a fundamental first step in any patient seeking a diagnosis. Primary care is indeed the first point of contact with the NHS for more than 90 per cent of our patients, yet surgeries in my constituency and across Wales are facing severe pressure, with patients contacting me regarding access on a daily basis. Llys Meddyg Surgery in Conwy ended its NHS contract last year as a result of an unmanageable workload, with both GPs working 12 hour days. Penrhyn Bay and Deganwy surgeries, seeing their GP provision drop from five to two. How do you mange those numbers of patients—thousands of them?GPs are telling me now that the system is at breaking point. We’ve seen years of chronic underinvestment—yes, Members—and 17 years of a Welsh Labour Government, propped up by Plaid Cymru and the Lib Dems, have actually been responsible for the funding for our GP services across Wales. We’ve seen the funding fall by £20 million over four years and the sector facing severe staff shortage and surgery closures, leading to the Royal College of General Practitioners warning that GPs in Wales are facing a perfect storm of increased demand, burgeoning workloads and a shrinking workforce. The BMA highlighted its findings in the autumn, that more than a quarter of GPs in Wales are now considering leaving the profession. Sixty per cent feel they do not have a good work-life balance, and 80 per cent are worried about the sustainability of their own provision. The BMA have also described it as a crisis in GP provision.Clearly, the system is under immense pressure. In 2005-06, GP care received over 10 per cent of NHS spend; now, it is down to less than 8 per cent. Where investment is made, it is not having the desired effect. The royal college of GPs has said of the recent £42.6 million invested into primary care that,‘any money that’s coming through the cluster system seems to be really very slow in actually making any difference to most of the practices. The way that the clusters work is very varied across Wales, so that is putting increased inequalities into the system.’ Cabinet Secretary, how are you monitoring this? In the fourth Assembly, the Health and Social Care Committee, of which I was a member, called on the Welsh Government to address the GP recruitment and retention crisis. Scotland has a significantly higher number of GPs per head than Wales, with 8.1 per 10,000, compared to just 6.5 in Wales. The latest figures show the number of GP practitioners in Wales fell from September 2014 by nine just to 1,997. Furthermore, the proportion and number of GPs aged 55 and over now cover 23 per cent of the workforce. So, it is vital that the Welsh Government is proactive in ensuring the workforce is futureproofed ahead of the deserved retirement of many of our hardworking GPs. Finally, our amendment, as touched on by my colleague, Angela Burns, seeks to recognise the importance that allied healthcare professionals such as pharmacists, nurses, physiotherapists, occupational therapists and paramedics play in ensuring that primary care is effectively delivered. Effective integration and joint working between the health and social care sectors is vital in relieving pressures on GPs. In conclusion, the immense pressure that the sector is under means that it is vital that the Welsh Government ensures significant investment in resources, people and infrastructure. My questions, to finish off, are: will you provide an update on the outcomes today of the implementation of your primary care workforce plan and the impact of the introduction of the clinical lead for primary care? What uptake has the refreshed employment offer and incentives for GPs coming to work in Wales had? We want to know. And finally, how are you working with medical schools in Wales to increase exposure to general practice during medical training? Cabinet Secretary, the crisis in GP provision is real; denial is not an option.

I call on the Cabinet Secretary for Health, Well-being and Sport, Vaughan Gething.

Vaughan Gething AC: Thank you, Presiding Officer. I do welcome today’s debate, which highlights the importance of high-quality primary care services, and the opportunity to respond to some of the comments that have been made, but I’ll start by saying the Welsh Government continues to invest in primary care services across Wales, and this is in direct contrast to England. We will continue to work in partnership with our GPs and other primary healthcare professionals to improve care for people right across Wales. We know the demand for GP and wider primary care services continues to increase, with about 19 million patient contacts a year. They continue to represent the great majority of NHS patient contact and act as a gateway to a range of other services. And I do recognise that winter places particular pressures on every part of our health and care system. Our whole system has only coped because of the extraordinary commitment of health and care staff. And I will note that that commitment by GPs has been poorly rewarded across our border in England, with a quite shameful attempt by the Prime Minister to blame GPs for winter pressures in accident and emergency departments. So, I want to state with absolute clarity: that is not and will not be my approach here in Wales. More than not blaming GPs, I took the decision to act in partnership with the BMA when I relaxed the quality and outcomes framework to the end of March, and that should relieve pressure on GPs and provide more time for patients. It is a clear example of this Government listening and acting, and that is the direct feedback I have had from GPs themselves.Now, GPs themselves also increasingly recognise that they need and want to be part of that wider primary care team. That will mean the role of the GP changing, where they will be providing services for the more complex patients and co-ordinating the wider primary care team. Our national primary care plan sets out key actions to provide a more integrated and multiprofessional service in each and every community. And increasingly, those teams are being created around our 64 clusters. The team will include GPs, pharmacists, nurses, therapists, dental teams, optometrists, mental health teams, social workers, the third sector and others working together to provide the right care at the right time and in the right place.And far from being a threat to general practice, as some feared, this new approach has significant buy-in now from our GP community. I’ve met a number of GPs who were, in honesty, broadly sceptical about the approach of clusters and a wider team, but they’re now convinced it is the right approach and they would not go back to the way of doing things in the past. And the use of money directly has been an important part of that. I just don’t recognise Janet Finch-Saunders’s comments that this hasn’t made any real difference. I met GPs today, as I have done on every GP visit, who can point to the direct contact and the direct use of that money and the difference it is making for their cluster, because they know their populations and are using that money accordingly. The £43 million that we’ve invested in primary care over this last year has helped to provide more than 250 additional posts—GPs, nurses, pharmacists, physios, paramedics, occupational therapists and others. There are a number of really good examples of advanced nurse practitioners making a really big difference. A good example I saw was in Carl Sargeant’s constituency, in Hope, where that’s really helping to cope with some of the difficulties they’ve had around recruiting another GP, and they recognise that that’s been a really important addition to their staff team. I’ve seen more pharmacists employed directly by clusters to support GPs, to take work away from them and to provide better quality of care to those individual constituents, but it can be for the GP to have more time with patients they really need to see. Of course, Choose Pharmacy—we’ve talked about it previously—is the platform that does mean that more support can and will be provided in community pharmacies across the country. I’m really pleased that many Members have recognised, both today in this debate and in earlier questions, the role of allied health professionals, and I welcome Angela Burns’s recognition of the Argyle Street pilot with occupational health, and we spoke earlier about Kidwelly and a number of different therapists there as well. But, in particular, physiotherapy has a big role to play in the future. Up to 30 per cent of a GP’s caseload will be musculoskeletal health issues, but about 85 per cent of those can be dealt with effectively by a physiotherapist without needing to see a GP. A pilot in north-west Wales has placed a physiotherapist in four GP practices, saving nearly 700 GP appointments over three months. As a result, that’s now been expanded to more than 40 GPs across north Wales. So, again, learning from what is working and doing things differently, rather than thinking about models simply from the past. We’ll do this by working in collaboration with GPs in Wales, and in particular to address the challenges of GP recruitment, as we are doing currently. These challenges are not unique to Wales. What is unique is the approach in sitting around a table talking, discussing and agreeing on what we should do. So, we have the national and international campaign launched in October 2016, making clear that Wales is an attractive place for doctors, including GPs, to train, work and live, and I’ll have more to say on that in the coming months and about the results of that campaign. As part of that, we did, though, announce an incentive scheme. So, trainees who take up a training place in a specific hard-to-recruit area will be eligible for a payment of up to £20,000, and, from August this year, that scheme will begin in Betsi Cadwaladr and Hywel Dda university health boards. A second incentive of a one-off payment of £2,000 for exam costs to all GP speciality training programme trainees to help cover final exams following study in Wales is also being introduced. Again, feedback thus far has been very positive about those two measures. We will, of course, continue to look at where medical training takes place, the numbers of medical trainees and, in particular, of course, opportunities for Welsh domiciled students within that. I want to be really clear that we have not cut funding to primary care. I’ve been disturbed by some of the alternative facts today that suggest we’ve taken money out of primary care. We have not done that at all. In fact, our overall financial investment across primary care has never been higher. In 2015-16, it was £878.5 million. That represented 13.7 per cent of the total health and social care spend. In percentage terms, that is more than Scotland spends on primary care on the same basis, in terms of defining primary care, as the Royal College of General Practitioners agreed in Scotland. The challenge always is how we divide up a finite budget to meet our competing priorities across both primary and secondary and the whole integrated system. We announced additional capital funding in the final budget of £40 million to re-engineer the health estate here in Wales and to deliver more integration between health and social care that will be targeted at that new generation of centres to make sure we deliver more care closer to home. But we know GPs and the wider primary care team face a very real challenge, and not just in winter. That is why primary care remains a priority for me. That is why I called a national event in October to bring together health boards to look at what they have done to deal with their challenges, to understand what the challenges are currently, what they’re doing about them, what the buy-in is from the GP communities and beyond. And it was a successful day, because I could see the way that GPs are having more of a buy-in and more of a leadership role in determining, with their health board partners, what they will do and who they will do it with. I’m really excited about the opportunity for more learning right across our whole system and that will only happen with a continued focus and continued emphasis on partnership. That is what I’m really encouraged about with our clusters—that partnership ethos that is developing, the leadership of GPs of their local primary healthcare team. That is an essential part of our future success for primary care here in Wales. I look forward to continuing to work with our GPs and our wider primary care team to deliver the high-quality primary care services that all of us would wish to see.

I call on Neil Hamilton to reply to the debate.

Neil Hamilton AC: Diolch, Lywydd. I’m pleased to respond to this debate and I welcome the contributions made by Angela Burns and Janet Finch-Saunders in particular, which added to the points that Caroline Jones made in her opening statement. I do deprecate the manner in which the Plaid Cymru spokesman began his speech today, which certainly subtracted from the sum total of human knowledge by misrepresenting the position of my own party on the national health service.

Rhun ap Iorwerth AC: Would you give way?

Neil Hamilton AC: Not yet, but I will give way later. Because UKIP in its manifesto in May in Wales, and in the general election in England last time, stood firmly on the principle of a national health service funded from taxation and free to the user at the point of delivery. It was a calumny and I’m afraid he demeaned the quality of debate and demeaned himself by the way in which he opened his speech. I’m disappointed, frankly. I am disappointed with him because we have a great deal of sympathy with the points that are made in the Plaid Cymru amendments, apart from amendment No. 5. No country in the world wants totally unrestricted immigration. We don’t have unrestricted immigration from the rest of the world outside the EU, but the tone of amendment 5 is that Plaid Cymru is actually opposed to all forms of immigration control because they regard that as a kind of racism and designed to increase hostility towards migrants. The reason why there is any hostility towards migrants today is very largely because of the failure of Governments to control immigration. [Interruption.] Plaid Cymru are evidently in denial—86 per cent of the country, according to the Government’s White Paper, which bears the name of the leader of Plaid Cymru, want immigration to be reduced; Plaid Cymru does not and I’m very happy to go into an election campaign on that basis.

Member of the Senedd: As are we.

Neil Hamilton AC: And no doubt you’ll do as well as you have in the past.

Rhun ap Iorwerth AC: Will you take an intervention? Will you take an intervention?

Neil Hamilton AC: It’s too late now. I haven’t time and frankly I don’t think it would be worth it. [Interruption.] But I want to refer also to—[Interruption.] I don’t think I’ll have time to reply to the debate.

It’s up to the Member whether he wants to take an intervention or not. Carry on, Neil Hamilton.

Neil Hamilton AC: I regret also that my friend, Lee Waters, spoiled what was otherwise a very good speech, with which I largely agreed, by making some caricature points about UKIP wanting to go back to the 1950s. It’s not even worth responding to that. I just wish that Members in this place would live up to the qualities of respect that they keep urging upon us but, so often, they don’t live up to themselves. I’ll give way to Mark Isherwood.

Mark Isherwood AC: Will you recognise—[Inaudible.]—you only have to go back five years when both BMA Cymru and the Royal College of General Practitioners aimed campaigns at Assembly Members warning them that we would get here, that 90 per cent of patient contacts are with general practice and yet funding as the share of the NHS cake had fallen, and they’ve had to relaunch those campaigns now because they didn’t listen.

Neil Hamilton AC: And so the point that I would make to Lee Waters is the fact that our motion didn’t mention many other good things, such as those which he adverted to in his speech, doesn’t mean that we want to take the NHS back to the 1950s or that we see the problems with reducing the proportion of the NHS spend on GPs as being the sole cause of its difficulties. I’m afraid that Plaid Cymru is not part of the solution; they’re part of the problem, because they supported Welsh Labour’s cuts over the years to the proportion of the NHS budget that is spent on GPs, and they support, and continue to support, budgets and policies that have increased the burdens on general practice. So, we know very well that, actually, they are part of the disease, rather than being the doctors that cure it.Caroline Jones referred in her speech, as did Angela Burns and Janet Finch-Saunders, to the realities of general practice. We have a static number of GPs in Wales, we have an ageing workforce amongst GPs and we have an ageing population, so that there is a pincer movement now between the limitations in the supply of medical services on the one hand and increased demand.Recruitment is a great difficulty. I accept that the Government is doing a great deal to solve the recruitment crisis, but, nevertheless, fundamentally, it is about rebalancing the NHS budget and putting more money into general practice, otherwise we’ll get ourselves into the same situation that we have in England, where hospitals are overwhelmed in A&E departments because of an inadequate provision of money for GP services.One of the interesting facts that has not been mentioned today about the NHS in Wales is that the number of GP retainers has fallen so substantially in recent years—people who work only for a few hours in the week. That is a means of increasing flexibility within the system and enabling these pressures to be dealt with. That’s something that I hope that the Government will address in the years ahead.The Government should tell us how it intends to meet the target that itself set of a six-hour maximum wait for housebound patients who can’t get to the surgery. I know of many cases, anecdotally, where people are waiting up to 20 hours for a home visit, and that is completely unacceptable in the modern world. So, it’s not back to the 1950s. Here we are in the twenty-first century, but we have to recognise that there is a limit, obviously, to the amount of money that can be spent on the health service. There is a limit to the amount of money that is available, but, nevertheless, I think, within the total, there needs to be a complete rebalancing to go back towards where we were five years ago, when a much greater proportion was spent on GPs, and I commend our motion to the Assembly this afternoon.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Therefore, I defer voting under this item until voting time.

Voting deferred until voting time.

10. 8. Voting Time

We’ve now reached voting time. Unless three Members wish for the bell to be rung, I will move to a vote. The first vote is on the UKIP debate. I call for a vote on the motion tabled in the name of Caroline Jones. Open the vote. Close the vote. Five in favour, no abstentions and 45 against. Therefore, the motion is not agreed.

Motion not agreed: For 5, Against 45, Abstain 0.

Result of the vote on motion NDM6214.Click to see vote results

I call for a vote on amendment 1, tabled in the name of Rhun ap Iorwerth. Open the vote. Close the vote. In favour 20, no abstentions, 31 against. Therefore, amendment 1 is not agreed.

Amendment not agreed: For 20, Against 31, Abstain 0.

Result of the vote on amendment 1 to motion NDM6214.Click to see vote results

Amendment 2: if amendment 2 is agreed, amendments 3, 4, 5 and 6 will be deselected. I call for a vote on amendment 2, tabled in the name of Jane Hutt. Open the vote. Close the vote. In favour 27, no abstentions, 24 against. Therefore, amendment 2 is agreed.

Amendment agreed: For 27, Against 24, Abstain 0.

Result of the vote on amendment 2 to motion NDM6214.Click to see vote results

Amendments 3, 4, 5 and 6 deselected.

We move, therefore, to amendment 7. I call for a vote on amendment 7, tabled in the name of Paul Davies. Open the vote. Close the vote. In favour 50, no abstentions, one against. Therefore, amendment 7 is agreed.

Amendment agreed: For 50, Against 1, Abstain 0.

Result of the vote on amendment 7 to motion NDM6214.Click to see vote results

I call for a vote on amendment 8, tabled in the name of Rhun ap Iorwerth. Open the vote. Close the vote. In favour 20, no abstentions, 31 against. Therefore, amendment 8 is not agreed.

Amendment not agreed: For 20, Against 31, Abstain 0.

Result of the vote on amendment 8 to motion NDM6214.Click to see vote results

I now call for a vote on the motion as amended.

Motion NDM6214 as amended:To propose that the National Assembly for Wales:1. Recognises that the majority of patients their first, and sometimes only, contact with the NHS is through general practice.2. Recognises the extent to which Welsh Government continues to invest in primary care services across Wales and the ongoing commitment to work in partnership with GPs and other primary care professionals to improve care for people across Wales.3. Recognises the importance that allied health care professionals play in ensuring that primary care is effectively delivered.

Open the vote. Close the vote. In favour 38, no abstentions, 12 against. Therefore, the motion as amended is agreed.

Motion NDM6214 as amended agreed: For 38, Against 12, Abstain 0.

Result of the vote on motion NDM6214 as amended.Click to see vote results

The proceedings aren’t finished. The short debate is yet to be held. I ask Members to leave quietly and quickly.

The Deputy Presiding Officer took the Chair.

11. 9. Short Debate: The Challenge of Recycling For Businesses and Residents in Rural Wales

We now move into the short debate. If you are leaving the Chamber, please do so quietly and quickly. Thank you. I’ll now call on Russell George to speak on the topic he has chosen. Russell George.

Russell George AC: Thank you, Deputy Presiding Officer. The title of my short debate today is ‘The challenges of recycling for businesses and residents in rural Wales.’ I’m going to start my contribution by patting the Government on the back and saying what a good job they’re doing, then I’m going to bring some cases forward that demonstrate that, if we don’t carry on the momentum, things will change. I’m also then going to show a video clip that highlights some of the cases in my own constituency. I’m going to give a minute of my time to Darren Millar, and I should also declare I’m a member of Powys County Council. So, I will begin by noting that the overall picture for Welsh recycling is a positive one. The Welsh Government’s current waste strategy, ‘Towards Zero Waste’, has set a very ambitious target of 70 per cent recycling by 2014-25 as a whole, and Wales’s recycling rates are already above the 58 per cent statutory recycling target, which was set in 2015-16. So, 19 out of 22 councils reached or exceeded that target, with the exception of outstanding issues in south-east Wales. The Welsh Government’s performance on recycling is largely a record that we in Wales can be proud of. Indeed, the general approach is good, with good, clear targets, proper monitoring and evaluation, so it’s a gold-standard approach, I think, from the Welsh Government, and it’s something that the rest of Europe can learn from and be adopted. So, there we are. So, a good approach so far. But Wales’s record of recycling is also reflective of a change in attitudes as well across society towards recycling, and this bodes well for the future. However, if we are to meet the Welsh Government’s 70 per cent target by 2025, it is essential that we keep up the momentum by providing innovative solutions to increase recycling rates whilst reducing the barriers of recycling, and that’s what I’m coming on to—the barriers of recycling. So, I’m therefore concerned that local authorities across Wales are curtailing both residential and commercial waste collections, largely as cost-cutting exercises, without providing the facilities to enable residents and businesses to increase their rates of recycling. So, we must ensure that waste management policies, such as the move to three-weekly collections, do not have unintended consequences in terms of increasing environmental crime such as fly-tipping, and ensure that Wales continues to be a European leader in recycling. So, for example, local authorities such as my own in Powys have moved to a three-weekly residual waste collection and, in some respects, are creating unnecessary barriers for residents and businesses when it comes to encouraging recycling. Indeed, I fear that current policies, unless addressed, will have an adverse effect on recycling rates in the county.I would now like to show a short video that illustrates some of the challenges that business owners and residents are currently facing. It’s just a couple of minutes, and then I will explore each of the cases. I will now ask for the video to be shown.

A DVD was shown. The transcription in quotation marks below is a transcription of the oral contributions on the DVD. The presentation can be accessed by following this link:

DVD presentation.

Lorna Hamer: ‘Hi, I’m Lorna from Quality Pipe Supports in Newtown, Powys. This is the area where we recycle. We recycle plastics, which we have to take over the border to Oswestry as there’s nowhere in Powys to recycle them. Paper and cardboard are the same; we have to take them to Oswestry. Metals we have to take to a local company. Wood—we recycle that, but there’s nowhere in Powys to take it to. We then recycle these plastic cups, which are recyclable—[Inaudible.]—there’s nowhere in Powys to recycle them. It’s the same with fabrics and aerosols; there’s nowhere to take them. We do pay the council a licence for recycling our goods, but there’s just nowhere for them to go.’Paul Martin: ‘The bin at the end of my lane, as you can see, is full of household waste. There are a lot of black bags, which shouldn’t be here at all—they should be purple. This will be spilled all out over the sides by the time of the collection, which will be in about 10 days’ time. We’ve noticed a big increase in the amount of waste in this bin since the closure of the Kerry recycling unit a few months ago.’Dan Morgan: ‘Hi, my name’s Dan Morgan. I’m the general manager here at Cefn Lea park in Newtown, Powys. Information about our rubbish at the moment, as this has become quite a problem for us as a business: a number of years ago, we used to have about 10 of these wheelie bins full of rubbish per week. Over the last three or four years, since the recycling has come into place for the council, we’ve cut this down to two bins per week, whereas the other eight bins worth of rubbish per week was being recycled in the food waste bins and plastic et cetera. Now, from 1 February, the council are cutting off recycling services for businesses, which is a major problem for us.’

Russell George AC: Thank you. So, I’ll just explore each of those cases. The first clip was from Lorna Hamer of Quality Pipe Supports, and I have to say I was surprised when Lorna said she can’t recycle cardboard and plastic anywhere in Powys. When I questioned her, there was one place in the next town, but, unfortunately, the form that they produced it in wasn’t accepted by that company and there was a minimum requirement to accept that cardboard as well. So, therefore, they had to go across the border to Oswestry. I should explain as well—the company has got a licence, so it can take its recyclable waste to a depot that is just up the road, which was working very well until a couple of years ago, but then what happened is the council reduced a lot of the items that can be recycled. They crossed them off and said, ‘You businesses can no longer take these items to the recycling point.’ When I questioned the council on this, they said this was down to cost saving; it was just not economically viable for them to accept these items anymore and that business should use private businesses—except there are no private businesses that are able to come into the area because it’s so rural; it’s not economically viable for them to do so either. So, a lot of recycling waste is either building up or is being put into the residual waste. It’s not what the company want to do. They’re putting it into the residual waste, and it’s costing them more money, of course, as well, to do that. So, effectively, this is now a tax on rural businesses, because nobody else will accept their recyclable waste.Paul Martin—this is not a business, he’s a local community champion in Kerry. Now, he’s making the point that people in his village were recycling very well, except then, of course, the council took away the recycling facility in the village and told them all to go to the next town, and said, ‘Go to Newtown, take all your recyclable waste there.’ Except the only thing is the council is now proposing to close either that or the Welshpool recycling facility. So, this is the case that he’s fighting as well. We know, last year, the council closed a facility in Machynlleth and told all its residents there, ‘You now have to go to Newtown to take your recyclable waste’. That’s a 60-mile round trip. So, when I went to an advice surgery in Machynlleth last year, one resident came with a load of bags and said, ‘Where are you going after this?’, and I said, ‘Back to Newtown’. He said, ‘Can you take all of this with you?’, and I had to place it all in my car, including a pot of oil. That was a 60-mile round trip. The resident couldn’t take the items himself simply because he’s only got a motorbike. It couldn’t fit on his motorbike. So, that’s the issue. What will happen is, if the Newtown facility closes, then residents will be expected to travel from Machynlleth—a 112-mile round trip. So, you’re going from the very west end of Wales all the way to the border. This is the situation that we’re finding ourselves in. I appreciate that the Cabinet Secretary might say, ‘Well, this is a matter for the county council’, but the question is: is this acceptable? Do we need to bring forward legislation, which I’ll come onto, and should this be happening? The Cabinet Secretary may say that I’m a Powys county councillor, but the reality is that this is a decision of a Powys County Council cabinet, and this is a decision that is happening right across rural authorities, wherever you are. It’s a case that I’m bringing forward and saying, ‘This is something I think the Welsh Government needs to step in and deal with.’The final case is the case of Daniel Morgan from Cefn Lea park, where they have 20,000 guests every year. He was saying that they’ve got 10 skips all going to residual waste—all going to landfill previously. They changed their systems; so, only two are going to landfill and eight are being recycled. Now, they’re going back to the position where all are going to have to be going to landfill again. This is on the assumption that, for example, they’ve got a lot of food waste. The council is now saying, ‘As from next week, we’re no longer going to collect your food waste; you’ve got to take it yourself to the recycling centre’, but they’ve not got a vehicle to take their food waste to the recycling centre, and that’s the position that they’re in.I’d also like to bring forward the final case of Dafarn Newydd Stores, a small shop in Llanwddyn, who will have their commercial recycling collection stopped at the end of this week. The store has informed me that they had no prior notification that the service was under review, and that the council have simply said that this will happen as of next week. I e-mailed the council about this—the Cabinet member—and this is the reply I got. I’m reading off the screen: ‘We are still able to provide a collection of trade residual waste, i.e. non-recyclables, but cannot justify the cost of collecting recyclables. Therefore, unfortunately, the only option is for the trader affected to put all waste into the residual bin, or take it to the household waste recycling centre via a permit scheme.’ They’ve actually given the advice to me that I should tell the business to put it in residual waste. This is the position that we’re in. Of course, that’s a 70-mile round trip for him, and if that recycling centre closes, then it’s going to go up to an even further distance as well.I visited a number of recycling centres myself around Montgomeryshire on several occasions, and I witnessed first-hand how popular the centres are, with queues of people often forming. That’s good, isn’t it? That’s what we want. So, of course, I’m concerned about the reduction of opening times at some of these centres, and also the potential closure of one of them as well. So, I would like to ask the Cabinet Secretary to have a look at changing outdated legislation in this regard. I am looking at the Environmental Protection Act 1990, which states that local authorities have a statutory obligation to provide its residents with at least one facility where they may deposit their household waste. So, I believe that the Welsh Government does have a role here in amending the Environmental Protection Act, which, in my view, is not fit for purpose at the moment. It’s not an acceptable situation that there can only be one recycling centre in the whole of a county area—and I’m thinking of rural counties like Powys. It’s not fit for purpose, and the legislation needs to be updated. It was brought in, of course, before local government reorganisation. So, when it was brought in, there were actually three councils in Powys. This is exactly why it needs to be updated.So, I sincerely hope that what I’ve said in this short debate today, and what residents have said in the case study shown earlier, will convince the Cabinet Secretary of the need to amend the Act, and also ensure that local authorities do all that they can to incentivise and increase recycling rates. It would be false economy if we were to decrease the cost of waste management on one hand and then, on the other hand, we see it having an adverse effect on recycling rates and environmental crime. I’m grateful to have had the opportunity to raise these issues in the short debate today. I look forward to a positive and constructive answer from the Cabinet Secretary. It’s no good telling me you’d rather Powys County Council sort it out; I’m a backbench Powys county councillor, and it’s the cabinet members that take the decisions. This isn’t just a Powys issue—it’s an issue for all rural authorities, and I hope I can work with the Cabinet Secretary at bringing forward some legislation to sort this issue out. I give one minute to Darren Millar.

Darren Millar AC: Thank you, Russell, and can I congratulate you on bringing this matter to the attention of the National Assembly? I’m not going to talk about four-weekly bin collections today and the impact that has on people’s behaviour and engagement with recycling, which I can tell you is very negative. But I do want to talk about access to civic amenity sites, because there is a great deal of waste that is produced by households that is not collected at the kerbside in my own local authority area of Conwy. Local residents in the south of that particular county are unable to access civic amenity sites in neighbouring local authority areas. They’re simply not allowed to turn up at a site in Denbighshire in order to get rid of small electrical items or waste that’s been created as a result of old furniture, or anything like that. Unfortunately, they are forced to make a two-hour round trip to their nearest civic amenity site, which is on the coast in Conwy, which is clearly an unacceptable situation. So, I fully endorse what Russell George has said about the need to look at access to these sorts of recycling and civic amenity points to make sure that not just businesses, but individual householders as well, are able to benefit from promoting recycling and making it as easy as possible for local householders. I look forward to hearing what the Government has to say about what it can do to make that access easier.

I now call on the Cabinet Secretary for Environment and Rural Affairs to reply to the debate. Lesley Griffiths.

Lesley Griffiths AC: Thank you, Deputy Presiding Officer, and thank you, Russell George, for bringing this subject forward for debate today. I think as you said in your opening remarks, we really have set our course as a leader in recycling and waste management. We’ve got the highest in the UK, and the fourth highest in Europe. I believe that our ambitions and our targets really will take us to first place in Europe and then, I think, the world, during the next few years. But I think also we must pay tribute to the public. You said that we really have taken the public with us on this journey, and our recycling targets have been reached because of the way the public have embraced it. I think I said it in the debate we had yesterday—it is now second nature to so many people in Wales. So, whilst I do agree there are challenges for businesses and residents in rural Wales, I think there are also opportunities as well. Rural authorities such as Powys do of course have specific challenges, and the distances, as you’ve mentioned, of rural collection rounds are larger, and facilities such as household waste and recycling centres are often further away for residents than in our more urban authorities. But I think we do need to be very careful how we characterise our local authorities. There are some city and Valleys authorities with rural areas, whilst many rural authorities have sizeable towns. I think local authorities have to take these factors into consideration when they’re planning and designing and delivering the services to businesses and residents. I think it’s really important—and again, you referred to this—that barriers aren’t put up for people. I also think that rural authorities here in Wales have managed these challenges very well. Last year, Wales achieved a 60.2 per cent municipal recycling rate. If you drill down into those figures and look at the specific authorities, rural authorities achieved an average of 62 per cent; Valleys authorities reached 59.3 per cent; and urban authorities 59 per cent. Some local authorities have consulted on reducing the number of household waste and recycling centres they provide, and I know some sites have closed. I think it’s also important that, when local authorities are looking at whether they should close a site, or even open a site, they need to look at what supermarkets are offering with these very good bring sites for material—banks, for instance—and good kerbside collections, too.Powys County Council covers a quarter of the area of Wales, so you can see just how large it is, and they have many sparsely populated areas where the provision of services, I know, can be a challenge. But I am advised that, despite these challenges, Powys is making—[Interruption.] Yes.

Russell George AC: I take your point about bringing to centres at supermarkets, for example, but a business can’t do that. If a business did that, they’d be fined.

Lesley Griffiths AC: No, absolutely. I was just making a general point that there are very good bring sites now, and they have to be taken into consideration. But you’re quite right—businesses obviously can’t use those.So, despite the challenges that I think Powys face, they are making excellent progress on recycling, and, again, it’s seen a significant increase in its recycling rate from the 59.1 per cent that was reported last year.The Welsh Government provides support to local authorities, including those that have large rural areas, through our collaborative change programme. Our objective is to help authorities improve recycling rates through the provision of excellent services, not just to residents, but to businesses as well. I do meet with local authorities regularly to discuss the challenges and opportunities that they face in relation to waste. Next Monday I’ll be chairing a meeting of the waste ministerial programme board to discuss these challenges further. What we need to do is translate our impressive municipal recycling rates into local jobs and opportunities for training and community regeneration. That’s the circular economy that we talk about. And I have to say that your video proved that point more than anything, that, if there aren’t facilities in Powys for those recyclable materials, we’re not going to achieve that circular economy. So, I would suggest that that’s perhaps something that could be looked at.All local authorities are part of this optimistic, life-enhancing agenda, which I think is being delivered for and by the people and communities of Wales. I’m really proud to celebrate the fact that Wales is a world leader in this area. I mentioned Powys’s very good recycling rates, so I’ll challenge Russell George: as a councillor, take credit for it, but, equally, you are part of the solution, and I appreciate what you’re saying about a backbencher, but it is really important that Powys council do provide these facilities.

Thank you very much. That brings today’s proceedings to a close. Thank you.

The meeting ended at 18:46.

QNR

Questions to the Cabinet Secretary for Health, Well-being and Sport

Paul Davies: What is the Welsh Government doing to improve health services in Pembrokeshire?

Vaughan Gething: Our priority is to provide the people of Pembrokeshire with health services that deliver the best possible outcomes for patients. We will, of course, be guided by the best and most up-to-date clinical evidence and advice to deliver high-quality care that the people of Pembrokeshire deserve.

Adam Price: Will the Cabinet Secretary make a statement on referral to treatment times in Hywel Dda University Health Board?

Vaughan Gething: I expect Hywel Dda to make the significant improvement that is required against their referral-to-treatment time targets and ensure every person is treated in a timely manner, based on clinical need.

Janet Finch-Saunders: Will the Cabinet Secretary make a statement on current orthopaedic treatment waiting times in Wales?

Vaughan Gething: I expect all patients to be seen and treated in a timely manner, based on clinical need. To assist this, we have invested a further £50 million during the year to maintain performance over the winter, which will assist in reducing waiting times.

Llyr Gruffydd: Will the Cabinet Secretary make a statement on local health board risk assessments?

Vaughan Gething: The Welsh Government expects all local health boards to have robust systems in place to identify, manage and minimise potential risks to patients, staff, services and the organisation. This is needed to prevent harm, ensure appropriate use of resources and maintain public confidence.

Mark Isherwood: Will the Cabinet Secretary outline how the Welsh Government is assisting people with dementia in Wales?

Vaughan Gething: The Welsh Government has provided more than £8 million of additional funding over the last two years to support dementia services across Wales. A consultation on the first dementia strategic action plan for Wales is now open until 3 April 2017.

Dai Lloyd: Will the Cabinet Secretary provide an update on the targeted intervention arrangements applying to Abertawe Bro Morgannwg Health Board?

Vaughan Gething: We are continuing to work closely with Abertawe Bro Morgannwg University Local Health Board. Support will be directed by the Welsh Government in agreement with the health board on the assistance that it requires.

Leanne Wood: Will the Cabinet Secretary provide an update on the treatment offered by the NHS for patients with multiple sclerosis?

Vaughan Gething: I expect health boards to ensure that people affected by a neurological condition such as multiple sclerosis to have timely access to high-quality care, integrated with social services where appropriate. This should be irrespective of where people live and how these services are delivered.

Questions to the Cabinet Secretary for Economy and Infrastructure

Mohammad Asghar: Will the Cabinet Secretary outline his priorities for improving transport in south-east Wales in 2017?

Ken Skates: The national transport FINANCE Plan, published in July 2015, sets out investment for transport and infrastructure and services for 2015-20 across all parts of Wales.

Nathan Gill: Will the Cabinet Secretary make a statement on transport infrastructure in North Wales?

Ken Skates: As set out in the national transport finance plan, we are making significant investments to modernise road and public transport infrastructure across North Wales and continue to press the UK Government for delivery of the schemes identified in the Network Rail’s Welsh route study in control period 6.

Caroline Jones: What actions is the Welsh Government taking to improve tourism in South Wales West?

Ken Skates: Our tourism strategy sets out our priorities to support the tourism industry. South Wales West offers a wide range of heritage, landscapes, activities and tourism destinations. These are promoted and marketed through our Visit Wales website, with capital and revenue support available for business development and regional support.

Sian Gwenllian: Will the Cabinet Secretary make a statement on the Welsh Government's vision for fair economic development across Wales?

Ken Skates: We recognise that prosperity brings security to individuals, families and communities and ‘Taking Wales Forward’ sets out our commitments to deliver prosperity for all.

Mike Hedges: Will the Cabinet Secretary make a statement on proposed infrastructure improvements in the Swansea Bay City region?

Ken Skates: We are working with partners on a range of infrastructure improvements, including better quality transport and digital connectivity.

Nick Ramsay: What actions is the Cabinet Secretary taking to support small businesses in Monmouthshire?

Ken Skates: Business support is available for entrepreneurs, micro, small and medium-sized businesses across Wales through our Business Wales service. Our focus remains on supporting innovation-driven entrepreneurs, jobs and the economy.